Is hepatectomy safe following Yttrium-90 therapy? A multi-institutional international experience. HPB : the official journal of the International Hepato Pancreato Biliary Association Melstrom, L. G., Eng, O. S., Raoof, M., Singh, G., Fong, Y., Latorre, K., Choi, G. H., Salem, R., Bentrem, D. J., Lewandowski, R., Makris, E., Poultsides, G., Dhar, V. K., Chadalavada, S., Shah, S. A., Johnson, A. C., Sekhar, A., Kies, D., Maithel, S. K., Rocha, F., Alseidi, A., Hagendoorn, J., Borel Rinkes, I. H., Fisher, A. V., Ronnekleiv-Kelly, S., Weber, S. M., Winslow, E. R., Abbott, D. E. 2019


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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