Surgical Strategies for Advanced Paediatric Hepatoblastoma: A Scoping Review

Background The surgical management of advanced paediatric hepatoblastoma remains variable, with extended hepatic resection and liver transplantation representing the two principal operative strategies. However, heterogeneity in definitions of resectability and decision-making criteria limits consistency in treatment selection. Methods A scoping review was conducted in accordance with Joanna Briggs Institute methodology and PRISMA-ScR guidelines. Studies reporting surgical strategies for advanced hepatoblastoma (PRETEXT III–IV or equivalent) published between 2000 and 2025were included. Data regarding surgical approaches, selection criteria, and perioperative and oncologic outcomes were extracted and narratively synthesized. Results Sixty-Five studies were included, comprising extended resection (n=8, 12.3%), liver transplantation (n=20, 30.8%), combined strategy reports (n=23, 35.3%), and reviews (n=12, 18.4%). Surgical decision-making extended beyond PRETEXT staging and incorporated vascular involvement, tumor distribution, chemotherapy response, and metastatic disease. Extended resection was primarily reported in anatomically favorable advanced disease, whereas liver transplantation showed greater consistency in defining functional unresectability. A subset of borderline resectable cases was identified in which both strategies were applied depending on institutional practice. Perioperative outcomes were generally acceptable across both approaches, while recurrence reporting was inconsistent and potentially influenced by tumor biology and extrahepatic disease. No direct comparative studies between extended resection versus transplantation were identified. Conclusion Surgical decision-making in advanced hepatoblastoma reflects a continuum of resectability rather than discrete treatment pathways. Extended resection and liver transplantation appear to function as complementary strategies within a multidimensional framework incorporating anatomical, functional, and biological factors. Standardization of definitions and prospective comparative studies are required to improve consistency in surgical decision-making.