In April 2008, liver transplantation (LT) for hepatoblastoma became covered under the Japanese medical insurance. Unresectable hepatoblastoma is considered an indication for LT; however, identifying “unresectable” hepatoblastoma is often difficult. Generally, unresectable tumors are those in cases categorized into post-treatment extent of disease grouping system POST-TEXT IV or III P+, V+. However, there are cases in which it is difficult to determine the resectability by preoperative imaging; although the tumor is considered resectable, a final surgical decision should be made at a facility capable of LT. Previously, it was safe to prioritize LT in cases of doubtful resectability owing to reports of extremely poor post-transplantation outcomes in salvage LT for reasons, such as recurrence after hepatectomy. Recently, there have been reports, including those from Japan, that the outcomes of salvage LT are good, and if the risk of long-term complications after LT is considered, challenging liver resection is reevaluated in this LT era. This article outlines the potential of atypical extreme hepatectomy using techniques used in transplant surgery, such as vascular reconstruction and organ preservation, and the surgical approach in cases with insufficient residual liver volume.
"},{"@language":"ja","@value":"肝芽腫に対する肝移植は2008年4月に保険収載されてから約15年が経過した．切除不能肝芽腫が肝移植適応とされるが，「切除不能」の判断は必ずしも容易ではない．一般的には，化学療法後においても4区域へ腫瘍進展が認められる場合（POST-TEXT IV）や腫瘍が3区域に限局していても主要な脈管に浸潤が疑われる場合（POST-TEXT III P+, V+）には切除不能と判断される．しかし，術前画像診断で切除可否を判断することが難しい場合もあり，仮に切除可能と考えられるような場合においても，肝移植に対応し得る施設での最終判断と手術が推奨されている．かつては，肝切除後再発などを理由とした救済的肝移植は，移植後の成績が著しく悪いとの報告から，切除可否が疑わしい症例は肝移植を優先させることが無難であると考えられていた．しかし，近年，わが国からの報告も含め，救済的肝移植の成績が決して悪くないとする報告もあり，肝移植後の長期的な合併症発症のリスクを考え併せると，移植を回避するためのチャレンジングな肝切除という治療選択も改めて見直されつつある．本稿では，血管再建や臓器保存などの移植手術の際に用いる技術を応用した肝切除術や残肝容量不足に対する対策など，非定型的高度肝切除術の概略と可能性について概説する．
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Tatsuro"},{"@language":"ja","@value":"田尻 達郎"}],"jpcoar:affiliationName":[{"@language":"en","@value":"Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University"},{"@language":"ja","@value":"九州大学大学院医学研究院小児外科学分野"}]}],"publication":{"publicationIdentifier":[{"@type":"PISSN","@value":"2187011X"},{"@type":"EISSN","@value":"21895384"}],"prism:publicationName":[{"@language":"ja","@value":"日本小児血液・がん学会雑誌"},{"@language":"en","@value":"The Japanese Journal of Pediatric Hematology / Oncology"},{"@language":"ja","@value":"日本小児血液・がん学会雑誌"},{"@language":"en","@value":"J Jpn Soc Pediatr Hematol Oncol"}],"dc:publisher":[{"@language":"en","@value":"The Japanese Society of Pediatric Hematology / Oncology"},{"@language":"ja","@value":"日本小児血液・がん学会"}],"prism:publicationDate":"2024","prism:volume":"61","prism:number":"2","prism:startingPage":"144","prism:endingPage":"147"},"reviewed":"true","availableAt":"2024","foaf:topic":[{"@id":"https://cir.nii.ac.jp/all?q=%E5%88%87%E9%99%A4%E4%B8%8D%E8%83%BD%E8%82%9D%E8%8A%BD%E8%85%AB","dc:title":"切除不能肝芽腫"},{"@id":"https://cir.nii.ac.jp/all?q=%E8%82%9D%E7%A7%BB%E6%A4%8D","dc:title":"肝移植"},{"@id":"https://cir.nii.ac.jp/all?q=%E9%9D%9E%E5%AE%9A%E5%9E%8B%E7%9A%84%E9%AB%98%E5%BA%A6%E8%82%9D%E5%88%87%E9%99%A4%E8%A1%93","dc:title":"非定型的高度肝切除術"},{"@id":"https://cir.nii.ac.jp/all?q=unresectable%20hepatoblastoma","dc:title":"unresectable hepatoblastoma"},{"@id":"https://cir.nii.ac.jp/all?q=liver%20transplantation","dc:title":"liver transplantation"},{"@id":"https://cir.nii.ac.jp/all?q=advanced%20hepatectomy","dc:title":"advanced hepatectomy"}],"project":[{"@id":"https://cir.nii.ac.jp/crid/1040854882537783296","@type":"Project","projectIdentifier":[{"@type":"KAKEN","@value":"22K08754"},{"@type":"JGN","@value":"JP22K08754"},{"@type":"URI","@value":"https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-22K08754/"}],"notation":[{"@language":"ja","@value":"腸管不全関連肝障害（IFALD）における新規細胞死フェロトーシス機序の解明"},{"@language":"en","@value":"Elucidation of the novel cell death mechanism of ferroptosis in intestinal failure associated liver disease (IFALD)"}]}],"dataSourceIdentifier":[{"@type":"JALC","@value":"oai:japanlinkcenter.org:2013283028"},{"@type":"KAKEN","@value":"PRODUCT-25526460"}]}