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 transplantation (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 eight patients, and the post-PM included seven patients. The median age at diagnosis was 26 vs. 40 months, with follow-up periods of 49 and 100 months, respectively. In the pre-PM group, 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 Preoperative PM prior to LT may not be effective in preventing postoperative recurrence in patients with hepatoblastoma presenting with pulmonary metastases at diagnosis.