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

Laleh G. Melstrom*, Oliver S. Eng, Mustafa Raoof, Gagandeep Singh, Yuman Fong, Karen Latorre, Gi H. Choi, Riad Salem, David Jason Bentrem, Robert J Lewandowski, Eleftherios Makris, George Poultsides, Vikrom K. Dhar, Seetharam Chadalavada, Shimul A. Shah, Aileen C. Johnson, Aarti Sekhar, Darren Kies, Shishir K. Maithel, Flavio RochaAdnan Alseidi, Jeroen Hagendoorn, Inne H.M. Borel Rinkes, Alexander V. Fisher, Sean Ronnekleiv-Kelly, Sharon M. Weber, Emily R. Winslow, Daniel E. Abbott

*Corresponding author for this work

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalHPB
DOIs
StatePublished - Jan 1 2019

Fingerprint

Yttrium
Hepatectomy
Liver
Therapeutics
Cholangiocarcinoma
Mortality
Liver Neoplasms
Operative Time
Colorectal Neoplasms
Neoplasms
Morbidity
Safety
Population

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Melstrom, L. G., Eng, O. S., Raoof, M., Singh, G., Fong, Y., Latorre, K., ... Abbott, D. E. (2019). Is hepatectomy safe following Yttrium-90 therapy? A multi-institutional international experience. HPB. https://doi.org/10.1016/j.hpb.2019.03.366
Melstrom, Laleh G. ; Eng, Oliver S. ; Raoof, Mustafa ; Singh, Gagandeep ; Fong, Yuman ; Latorre, Karen ; Choi, Gi H. ; Salem, Riad ; Bentrem, David Jason ; Lewandowski, Robert J ; Makris, Eleftherios ; Poultsides, George ; Dhar, Vikrom K. ; Chadalavada, Seetharam ; Shah, Shimul A. ; Johnson, Aileen C. ; Sekhar, Aarti ; Kies, Darren ; Maithel, Shishir K. ; Rocha, Flavio ; Alseidi, Adnan ; Hagendoorn, Jeroen ; Borel Rinkes, Inne H.M. ; Fisher, Alexander V. ; Ronnekleiv-Kelly, Sean ; Weber, Sharon M. ; Winslow, Emily R. ; Abbott, Daniel E. / Is hepatectomy safe following Yttrium-90 therapy? A multi-institutional international experience. In: HPB. 2019.
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title = "Is hepatectomy safe following Yttrium-90 therapy? A multi-institutional international experience",
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.",
author = "Melstrom, {Laleh G.} and Eng, {Oliver S.} and Mustafa Raoof and Gagandeep Singh and Yuman Fong and Karen Latorre and Choi, {Gi H.} and Riad Salem and Bentrem, {David Jason} and Lewandowski, {Robert J} and Eleftherios Makris and George Poultsides and Dhar, {Vikrom K.} and Seetharam Chadalavada and Shah, {Shimul A.} and Johnson, {Aileen C.} and Aarti Sekhar and Darren Kies and Maithel, {Shishir K.} and Flavio Rocha and Adnan Alseidi and Jeroen Hagendoorn and {Borel Rinkes}, {Inne H.M.} and Fisher, {Alexander V.} and Sean Ronnekleiv-Kelly and Weber, {Sharon M.} and Winslow, {Emily R.} and Abbott, {Daniel E.}",
year = "2019",
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doi = "10.1016/j.hpb.2019.03.366",
language = "English (US)",
journal = "HPB",
issn = "1365-182X",
publisher = "John Wiley and Sons Inc.",

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Melstrom, LG, Eng, OS, Raoof, M, Singh, G, Fong, Y, Latorre, K, Choi, GH, Salem, R, Bentrem, DJ, Lewandowski, RJ, Makris, E, Poultsides, G, Dhar, VK, Chadalavada, S, Shah, SA, Johnson, AC, Sekhar, A, Kies, D, Maithel, SK, Rocha, F, Alseidi, A, Hagendoorn, J, Borel Rinkes, IHM, Fisher, AV, Ronnekleiv-Kelly, S, Weber, SM, Winslow, ER & Abbott, DE 2019, 'Is hepatectomy safe following Yttrium-90 therapy? A multi-institutional international experience', HPB. https://doi.org/10.1016/j.hpb.2019.03.366

Is hepatectomy safe following Yttrium-90 therapy? A multi-institutional international experience. / Melstrom, Laleh G.; Eng, Oliver S.; Raoof, Mustafa; Singh, Gagandeep; Fong, Yuman; Latorre, Karen; Choi, Gi H.; Salem, Riad; Bentrem, David Jason; Lewandowski, Robert J; Makris, Eleftherios; Poultsides, George; Dhar, Vikrom K.; Chadalavada, Seetharam; Shah, Shimul A.; Johnson, Aileen C.; Sekhar, Aarti; Kies, Darren; Maithel, Shishir K.; Rocha, Flavio; Alseidi, Adnan; Hagendoorn, Jeroen; Borel Rinkes, Inne H.M.; Fisher, Alexander V.; Ronnekleiv-Kelly, Sean; Weber, Sharon M.; Winslow, Emily R.; Abbott, Daniel E.

In: HPB, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Is hepatectomy safe following Yttrium-90 therapy? A multi-institutional international experience

AU - Melstrom, Laleh G.

AU - Eng, Oliver S.

AU - Raoof, Mustafa

AU - Singh, Gagandeep

AU - Fong, Yuman

AU - Latorre, Karen

AU - Choi, Gi H.

AU - Salem, Riad

AU - Bentrem, David Jason

AU - Lewandowski, Robert J

AU - Makris, Eleftherios

AU - Poultsides, George

AU - Dhar, Vikrom K.

AU - Chadalavada, Seetharam

AU - Shah, Shimul A.

AU - Johnson, Aileen C.

AU - Sekhar, Aarti

AU - Kies, Darren

AU - Maithel, Shishir K.

AU - Rocha, Flavio

AU - Alseidi, Adnan

AU - Hagendoorn, Jeroen

AU - Borel Rinkes, Inne H.M.

AU - Fisher, Alexander V.

AU - Ronnekleiv-Kelly, Sean

AU - Weber, Sharon M.

AU - Winslow, Emily R.

AU - Abbott, Daniel E.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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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