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 Rocha & 8 others Adnan 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

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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.}",
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day = "1",
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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