Is hepatectomy safe following Yttrium-90 therapy? A multi-institutional international experience
Authors
Laleh G. Melstrom ; Oliver S. Eng ; Mustafa Raoof ; Gagandeep Singh ; Yuman Fong ; Karen Latorre ; Gi H. Choi ; Riad Salem ; David J. Bentrem ; Robert Lewandowski ; Eleftherios Makris ; George Poultsides ; Vikrom K. Dhar ; Seetharam hadalavada ; Shimul A. Shah ; Aileen C. Johnson ; Aarti Sekhar ; Darren Kies ; Shishir K. Maithel ; Flavio Rocha ; Adnan Alseidi ; Jeroen Hagendoorn ; Inne H.M. Borel Rinkes ; Alexander V. Fisher ; Sean Ronnekleiv-Kelly ; Sharon M. Weber ; Emily R. Winslow ; Daniel E. Abbott
Single institution reports demonstrate variable safety profiles when liver-directed therapy with Yttrium-90 (Y-90) is followed by hepatectomy. We hypothesized that in well-selected patients, hepatectomy after Y90 is feasible and safe.
METHODS:
Nine institutions contributed data for patients undergoing Y90 followed by hepatectomy (2008-2017). Clinicopathologic and perioperative data were analyzed, with 90-day morbidity and mortality as primary endpoints.
RESULTS:
Forty-seven patients were included. Median age was 59 (20-75) and 62% were male. Malignancies treated included hepatocellular cancer (n = 14; 30%), colorectal cancer (n = 11; 23%), cholangiocarcinoma (n = 8; 17%), neuroendocrine (n = 8; 17%) and other tumors (n = 6). The distribution of Y-90 treatment was: right (n = 30; 64%), bilobar (n = 14; 30%), and left (n = 3; 6%). Median future liver remnant (FLR) following Y90 was 44% (30-78). Resections were primarily right (n = 16; 34%) and extended right (n = 14; 30%) hepatectomies. The median time to resection from Y90 was 196 days (13-947). The 90-day complication rate was 43% and mortality was 2%. Risk factors for Clavien-Dindo Grade>3 complications included: number of Y-90-treated lobes (OR 4.5; 95% CI1.14-17.7; p = 0.03), extent of surgery (p = 0.04) and operative time (p = 0.009).
CONCLUSIONS:
These data demonstrate that hepatectomy following Y-90 is safe in well-selected populations. This multi-disciplinary treatment paradigm should be more widely studied, and potentially adopted, for patients with inadequate FLR.