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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