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

Abstract

BACKGROUND\nSingle 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.\n\n\nMETHODS\nNine 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.\n\n\nRESULTS\nForty-seven patients were included. Median age was 59 (20-75) and 62% were male. Malignancies treated included hepatocellular cancer (n\xa0=\xa014; 30%), colorectal cancer (n\xa0=\xa011; 23%), cholangiocarcinoma (n\xa0=\xa08; 17%), neuroendocrine (n\xa0=\xa08; 17%) and other tumors (n\xa0=\xa06). The distribution of Y-90 treatment was: right (n\xa0=\xa030; 64%), bilobar (n\xa0=\xa014; 30%), and left (n\xa0=\xa03; 6%). Median future liver remnant (FLR) following Y90 was 44% (30-78). Resections were primarily right (n\xa0=\xa016; 34%) and extended right (n\xa0=\xa014; 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\xa0=\xa00.03), extent of surgery (p\xa0=\xa00.04) and operative time (p\xa0=\xa00.009).\n\n\nCONCLUSIONS\nThese 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.