Introduction: In children, hepatoblastoma (HB) is preferentially managed by hepatic resection (HR).  However, in irresectable cases, liver transplantation (LT) is the only option. We compared outcomes following HR and LT for HB.

Methods: We retrospectively reviewed HB cases that underwent surgical management over a 25-year period (1996-2021). We assessed overall survival and disease-free survival at 1-, 5- and 10-years using the Kaplan-Meier method, log-rank tests, and multivariable Cox regression.

Results: We included 76 children, 46 (60.5%) male and 30 (39.5%) female, with a median age at diagnosis of 24.7 months (IQR: 9.41-50.38). HR was performed in 49 (64.5%) and LT in 27 (35.5%). Both groups were comparable by age, sex, alpha-fetoprotein levels, histology, and metastatic disease at diagnosis. The LT group had longer median time from diagnosis to surgery (4.4 vs 3.55 months; p<0.004), more multifocal tumors (51.9% vs 4.1%; p<0.001), and vascular invasion (63% vs 22.4%; p<0.001). Both groups had similar 1-, 5- and 10-year overall survival rates (p=0.97), respectively 93%, 89% and 87% for HR; and 100%, 93% and 85% for LT. Likewise, disease-free survival at 1, 5 and 10 years was 93.5%, 82.6% and 82.6% for HR; and 100%, 93% and 85% for LT (p=0.89). In multivariate analysis, metastatic disease at diagnosis (HR 6.14, CI 1.37-27.51), multifocality (HR 5.29, CI 1.49-18.74), and extrahepatic abdominal involvement (HR 11.11, CI 2.14-57.58) were associated with decreased overall survival.

Conclusion: Children with hepatoblastoma who underwent both HR and LT had excellent long-term overall survival. Multifocality, metastatic disease, and extrahepatic abdominal involvement impact outcomes.