introductionHepatoblastoma with tumor thrombi involving three hepatic veins or extending into the inferior vena cava (IVC) toward the right atrium is mostly considered unresectable. In the current era of liver transplantation for unresectable hepatoblastoma with stable outcomes, it is challenging to choose extreme hepatectomy with hypothermic perfusion under total hepatic vascular exclusion. We herein report a successful case of extreme liver resection with CASE PRESENTATION: A 10-month-old girl was referred for an unresectable hepatoblastoma (alpha-fetoprotein [AFP] 592037 ng/mL), approximately 12 cm in size, occupying the right lobe with a tumoral thrombus extending into the IVC toward the right atrium. The tumor continued to involve three hepatic veins and the IVC after intensive chemotherapy, which was categorized into POSTTEXT III (P1, V3, M0) staging. We planned an

conclusionsResection of liver tumors invading the IVC or hepatic veins has become possible with technical lessons learned from liver transplantation skills. This procedure is a realistic option for achieving surgical cure and improving the quality of life in select pediatric patients with otherwise unresectable hepatoblastomas.