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Multicenter Study
. 2019 Nov;21(11):1520-1526.
doi: 10.1016/j.hpb.2019.03.366. Epub 2019 Apr 17.

Is hepatectomy safe following Yttrium-90 therapy? A multi-institutional international experience

Laleh G Melstrom  1 , Oliver S Eng  2 , Mustafa Raoof  2 , Gagandeep Singh  2 , Yuman Fong  2 , Karen Latorre  3 , Gi H Choi  3 , Riad Salem  4 , David J Bentrem  4 , Robert Lewandowski  4 , Eleftherios Makris  5 , George Poultsides  5 , Vikrom K Dhar  6 , Seetharam Chadalavada  6 , Shimul A Shah  6 , Aileen C Johnson  7 , Aarti Sekhar  7 , Darren Kies  7 , Shishir K Maithel  7 , Flavio Rocha  8 , Adnan Alseidi  8 , Jeroen Hagendoorn  9 , Inne H M Borel Rinkes  9 , Alexander V Fisher  10 , Sean Ronnekleiv-Kelly  10 , Sharon M Weber  10 , Emily R Winslow  10 , Daniel E Abbott  10
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Free article
Multicenter Study

Is hepatectomy safe following Yttrium-90 therapy? A multi-institutional international experience

Laleh G Melstrom et al. HPB (Oxford). 2019 Nov.
Free article

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.

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