ASO Author Reflections: Rethinking Surgical Strategies for Pediatric Liver Tumors with Vascular Involvement: Resection with Vascular Reconstruction as an Alternative to Transplantation

PASTLiver tumors in children that present as large, centrally located masses involving the hepatic venous confluence or the inferior vena cava (IVC), pose significant surgical challenges. 1 In such cases, some centers may favor liver transplantation (LT) due to the complexity of liver resection with vascular reconstruction and the risk of local recurrence. 2,3However, LT carries notable drawbacks, including limited organ availability, the need for lifelong immunosuppression, and potential long-term complications. 4Given these concerns, organ-preserving alternatives are particularly desirable in pediatric patients whenever feasible and oncologically effective.While vascular reconstruction has been investigated in adult liver surgery, its outcomes in pediatric liver tumor surgery remain unstudied.Our study aimed to assess the safety, feasibility, and oncological outcomes of extended liver resections with vascular reconstruction of the hepatic veins and/or the IVC as an alternative to LT in select cases. 5