Evaluating the impact of pulmonary metastasectomy prior to liver transplantation in pediatric hepatoblastoma patients

PURPOSE: Liver transplantation (LT) has improved the outcomes of patients with unresectable hepatoblastoma; however, pulmonary metastases remain a major prognostic challenge. Therefore, we retrospectively evaluated the impact of pulmonary metastasectomy (PM) performed before LT. METHODS: Between November 2002 and November 2023, 15 children diagnosed with hepatoblastoma with pulmonary metastases underwent PM. All patients received preoperative chemotherapy. Patients requiring LT underwent PM prior to LT (pre-PM), whereas others underwent PM following hepatectomy (post-PM). Clinical characteristics, alpha-fetoprotein (AFP) levels, PM details, and recurrence rates were compared. RESULTS: The pre-PM included 8 patients, and the post-PM included 7 patients. The median age at diagnosis was 26 and 40 months, with follow-up periods of 49 and 100 months, respectively. In the pre-PM, 5 patients (63%) required repeated PM after LT, with a median of 3 PMs; all experienced recurrence, and 4 (80%) developed uncontrolled pulmonary metastases. In the post-PM, the median number of PMs was 1; 3 patients (43%) experienced recurrence, but all achieved recurrence-free survival after repeated PM. No significant differences in the baseline characteristics were observed. CONCLUSION: Whether PM prior to LT is truly beneficial remains to be determined, and further validation through the accumulation of additional cases is required.