To investigate the diagnosis, treatment and prognosis of complicated hepatectomy for hepatoblastoma (HB) complicated with inferior vena cava (IVC) tumor thrombus, atrial tumor thrombus, renal vein tumor thrombus and bilateral lung metastases.

Clinical data of a child with HB admitted to PLA Rocket Force General Hospital on February 14, 2024 were retrospectively analyzed. The boy, aged 2 years and 7 months, weighing 12.3 kg, was admitted to the hospital due to the space-occupied lesion in the liver for more than 4 months. After comprehensive examinations, he was diagnosed with HB complicated with IVC tumor thrombus, atrial tumor thrombus and renal vein tumor thrombus, and postoperative bilateral lung metastases. After MDT consultation, liver tumor resection (extended right hemihepatectomy+caudate lobectomy), IVC replacement, allogenic vessel transplantation, renal vein-allogenic vessel anastomosis and hepatic vein-allogenic vessel anastomosis were determined. The informed consent of the patient was obtained and the local ethical committee approval was received.

The operation was carried out according to preoperative planning. The right atrium was partially resected (approximately 1 cm). Postoperative, ultrasound showed that the blood flow at the anastomosis was smooth. No evident abnormality in liver and kidney function was found after operation. No tumor cells were found at the atrial margin. The child was discharged at postoperative 13 d. He received 1 session of carboplatin+adriamycin chemotherapy in a local hospital. Warfarin was used for regular anticoagulation. At postoperative 4 months, he was admitted because of a large amount of abdominal and pelvic effusion. After examination, he was diagnosed with the stenosis of hepatic vein opening and given with balloon dilation.At postoperative 5 months, he was admitted due to abdominal distension and high fever. Hepatic venography under general anesthesia showed severe stenosis of hepatic vein opening, and balloon angioplasty was performed. At postoperative 7 months, he was hospitalized due to pericardial, peritoneal and pleural effusions, and underwent puncture drainage. The blood oxygen saturation was maintained at approximately 98%, and the child was transferred to ICU. After fluid therapy and volume expansion combined with internal environment correction, hepatic venography+balloon angioplasty+stent placement were performed under general anesthesia. Postoperative ultrasound showed that pericardial and pleural effusions were absent. Drainage catheter was removed, albumin was supplemented appropriately, and anticoagulation was performed. The child was discharged smoothly. At 16 months after operation, AFP level was decreased to 2 μg/L. No significant abnormality was detected in the liver, kidney, heart and lung.

The treatment of HB, especially in the case of IVC invasion, requires comprehensive MDT diagnosis and treatment. Radical surgical resection is still the curative treatments.