Impact of Complete Pulmonary Metastasectomy on the Prognosis of Children with Metastatic Hepatoblastoma: A Single Center Experience

Background The survival rate of patients with hepatoblastoma (HB) with distant metastases is unsatisfactory. Although dose-dense chemotherapy with a high incidence of ototoxicity improves the prognosis of these patients, surgical metastasectomy may provide an alternative treatment option avoiding drug side effects. The aim of this study was to examine the efficacy of “complete” pulmonary metastasectomy for the treatment of children with metastatic HB. Methods This retrospective study retrieved data from 2004 to 2015 on 22 children with metastatic HB. Separated into two groups; children who underwent only hepatectomy (group H, 14 cases), and children who underwent primary or rescue liver transplantation (group T, eight cases). Each patient was administered initial chemotherapy according to JPLT-2, SIOPEL3 or PLADO protocols. Over the course of this study, we performed metastasectomies for all detectable pulmonary metastases. Indocyanine green fluorescent navigation was used for 15 patients to detect tiny metastases. The follow-up period for survivors after the last metastasectomy ranged from 36 to 186 months. Results The cumulative disease-free 5-year survival rate was 84% in group H and 33% in group T. The median number of resected pulmonary metastatic lesions was 10.5 (range: 1-42) in group H and 3.5 (range: 1–97) in group T. None of the survivors developed hearing or respiratory impairment. Conclusions Complete pulmonary metastasectomy improves the prognosis of patients with metastatic HB with conventional chemotherapy, especially in the patients with primary HB lesions removed without liver transplantation.