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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 
Citation
 HPB, Vol.21(11) : 1520-1526, 2019 
Journal Title
 HPB 
ISSN
 1365-182X 
Issue Date
2019
Abstract
BACKGROUND: 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.
Full Text
https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S1365182X19304915
DOI
10.1016/j.hpb.2019.03.366
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Choi, Gi Hong(최기홍) ORCID logo https://orcid.org/0000-0002-1593-3773
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/175216
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