Cure of multifocal panhepatic hepatoblastoma: is liver transplantation always necessary?

Hepatoblastoma state of the art

“…Considerable debate exists regarding whether or not multifocal areas that radiographically clear should be considered sterilized if the nodules are no longer detectable by imaging [37]. Should microscopic tumor residual be assumed, and the patient undergo transplantation?…”

“…All four had been treated by conservative resection, and all four died, three from tumor progression and the other from graft failure after rescue orthotopic liver transplant for a second relapse [38]. In other series, although some residual islets that were resected were proven still viable, partial resection was performed with success: the authors conclude, however, from their experience that total hepatectomy may remain the preferable choice [34,37].…”

Avoiding liver transplantation in post‐treatment extent of disease III and IV hepatoblastoma

“…A possible benefit from surgical resection in some patients with advanced hepatoblastoma who are potential candidates for liver transplantation has recently been reported. 12,17,18 It was found that non-transplant resection techniques in selected POST-TEXT III and IV hepatoblastoma achieved a similar survival rate to primary liver transplantation. 10,12,17,18 This reflects the controversial role of microscopic residual disease and its prognostic effect.…”

Imaging of multifocal liver lesions in children and adolescents

“…Although about 80% present as a solitary mass, about 20% are multifocal with a variable number of satellite lesions [ 17 ] . Multifocal hepatoblastoma is associated with reduced event-free survival, and may require total hepatectomy and subsequent liver transplantation (in the absence of contraindicative metastatic disease) [ 19 , 20 ] .…”