Curative resection by superior hepatectomy for advanced hepatoblastoma facilitated by the presence of a large inferior right hepatic vein.

BACKGROUND: Despite the success of neoadjuvant chemotherapy some patients with hepatoblastoma remain unresectable due to the proximity of important vascular structures. We report an unconventional surgical resection via a superior hepatectomy in a 16-month-old infant with hepatoblastoma. CASE OUTLINE: Staging CT scan revealed extensive replacement of the superior portion of the liver with complete occlusion of the three hepatic veins, and with extension into the inferior vena cava and right atrium. Following chemotherapy the tumour was confined to the superior portion of the liver with obstruction of the right, middle and left hepatic veins, but with a large patent inferior hepatic vein draining the inferior liver segments. Superior hepatectomy was performed without complication. DISCUSSION: Complete surgical resection offers the only chance of cure for patients with hepatoblastoma. This case illustrates that careful preoperative planning facilitated aggressive surgical clearance with superior hepatectomy for curative resection of an otherwise non-resectable tumour.