90Y radiation lobectomy: Outcomes following surgical resection in patients with hepatic tumors and small future liver remnant volumes

Robert J. Lewandowski*, Larry Donahue, Attasit Chokechanachaisakul, Laura Kulik, Samdeep Mouli, Juan Caicedo, Michael Abecassis, Jonathan Fryer, Riad Salem, Talia Baker

*Corresponding author for this work

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Background: The purpose of this study is to assess operative, post-operative, and long-term outcomes in patients who underwent radiation lobectomy (RL) for tumor control and/or hypertrophy of small future liver remnant (FLR) prior to resection. Methods: Right lobar +/− segment 4 radioembolization was performed prior to lobectomy/tri-segmentectomy in patients with hepatic tumor but inadequate FLR. Parenchymal/tumor volumes were calculated from pre/post-RL imaging; FLR/%FLR hypertrophy were determined. Complications were graded by the Clavien-Dindo classification. Results: Thirteen patients (HCC n = 10, cholangiocarcinoma n = 2, mCRC n = 1) underwent RL prior to resection. The median time between RL and post-RL imaging was 40 days (23–190 days); the median time to resection was 86 days (30–210 days). Median FLR increased significantly [pre: 33% (22–43%); post: 43% (29–69%), P < 0.01] to yield a median %FLR hypertrophy of 30% (4–105%). The median hospital stay after resection was 4 days (3–11 days). Transient hepatobiliary toxicities normalized post-operatively. Ninety-two percent of resected tumors had >50% pathologic necrosis. Median follow up time after surgery was 604 days (144–1,416 days); one death occurred. Conclusions: In this preliminary study, radiation lobectomy was a safe and effective method to achieve remnant liver hypertrophy while providing tumor control. This approach may facilitate safe resection and favorable post-operative outcomes.J. Surg. Oncol. 2016;114:99–105.

Original languageEnglish (US)
Pages (from-to)99-105
Number of pages7
JournalJournal of Surgical Oncology
Volume114
Issue number1
DOIs
StatePublished - Jul 1 2016

Fingerprint

Radiation
Liver
Neoplasms
Hypertrophy
Cholangiocarcinoma
Segmental Mastectomy
Tumor Burden
Necrosis

Keywords

  • future liver remnant
  • hepatectomy
  • radioembolization
  • resection
  • yttrium-90

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

@article{ff6ea0613d744dc1bc3ccb1314358424,
title = "90Y radiation lobectomy: Outcomes following surgical resection in patients with hepatic tumors and small future liver remnant volumes",
abstract = "Background: The purpose of this study is to assess operative, post-operative, and long-term outcomes in patients who underwent radiation lobectomy (RL) for tumor control and/or hypertrophy of small future liver remnant (FLR) prior to resection. Methods: Right lobar +/− segment 4 radioembolization was performed prior to lobectomy/tri-segmentectomy in patients with hepatic tumor but inadequate FLR. Parenchymal/tumor volumes were calculated from pre/post-RL imaging; FLR/{\%}FLR hypertrophy were determined. Complications were graded by the Clavien-Dindo classification. Results: Thirteen patients (HCC n = 10, cholangiocarcinoma n = 2, mCRC n = 1) underwent RL prior to resection. The median time between RL and post-RL imaging was 40 days (23–190 days); the median time to resection was 86 days (30–210 days). Median FLR increased significantly [pre: 33{\%} (22–43{\%}); post: 43{\%} (29–69{\%}), P < 0.01] to yield a median {\%}FLR hypertrophy of 30{\%} (4–105{\%}). The median hospital stay after resection was 4 days (3–11 days). Transient hepatobiliary toxicities normalized post-operatively. Ninety-two percent of resected tumors had >50{\%} pathologic necrosis. Median follow up time after surgery was 604 days (144–1,416 days); one death occurred. Conclusions: In this preliminary study, radiation lobectomy was a safe and effective method to achieve remnant liver hypertrophy while providing tumor control. This approach may facilitate safe resection and favorable post-operative outcomes.J. Surg. Oncol. 2016;114:99–105.",
keywords = "future liver remnant, hepatectomy, radioembolization, resection, yttrium-90",
author = "Lewandowski, {Robert J.} and Larry Donahue and Attasit Chokechanachaisakul and Laura Kulik and Samdeep Mouli and Juan Caicedo and Michael Abecassis and Jonathan Fryer and Riad Salem and Talia Baker",
year = "2016",
month = "7",
day = "1",
doi = "10.1002/jso.24269",
language = "English (US)",
volume = "114",
pages = "99--105",
journal = "Journal of Surgical Oncology",
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TY - JOUR

T1 - 90Y radiation lobectomy

T2 - Outcomes following surgical resection in patients with hepatic tumors and small future liver remnant volumes

AU - Lewandowski, Robert J.

AU - Donahue, Larry

AU - Chokechanachaisakul, Attasit

AU - Kulik, Laura

AU - Mouli, Samdeep

AU - Caicedo, Juan

AU - Abecassis, Michael

AU - Fryer, Jonathan

AU - Salem, Riad

AU - Baker, Talia

PY - 2016/7/1

Y1 - 2016/7/1

N2 - Background: The purpose of this study is to assess operative, post-operative, and long-term outcomes in patients who underwent radiation lobectomy (RL) for tumor control and/or hypertrophy of small future liver remnant (FLR) prior to resection. Methods: Right lobar +/− segment 4 radioembolization was performed prior to lobectomy/tri-segmentectomy in patients with hepatic tumor but inadequate FLR. Parenchymal/tumor volumes were calculated from pre/post-RL imaging; FLR/%FLR hypertrophy were determined. Complications were graded by the Clavien-Dindo classification. Results: Thirteen patients (HCC n = 10, cholangiocarcinoma n = 2, mCRC n = 1) underwent RL prior to resection. The median time between RL and post-RL imaging was 40 days (23–190 days); the median time to resection was 86 days (30–210 days). Median FLR increased significantly [pre: 33% (22–43%); post: 43% (29–69%), P < 0.01] to yield a median %FLR hypertrophy of 30% (4–105%). The median hospital stay after resection was 4 days (3–11 days). Transient hepatobiliary toxicities normalized post-operatively. Ninety-two percent of resected tumors had >50% pathologic necrosis. Median follow up time after surgery was 604 days (144–1,416 days); one death occurred. Conclusions: In this preliminary study, radiation lobectomy was a safe and effective method to achieve remnant liver hypertrophy while providing tumor control. This approach may facilitate safe resection and favorable post-operative outcomes.J. Surg. Oncol. 2016;114:99–105.

AB - Background: The purpose of this study is to assess operative, post-operative, and long-term outcomes in patients who underwent radiation lobectomy (RL) for tumor control and/or hypertrophy of small future liver remnant (FLR) prior to resection. Methods: Right lobar +/− segment 4 radioembolization was performed prior to lobectomy/tri-segmentectomy in patients with hepatic tumor but inadequate FLR. Parenchymal/tumor volumes were calculated from pre/post-RL imaging; FLR/%FLR hypertrophy were determined. Complications were graded by the Clavien-Dindo classification. Results: Thirteen patients (HCC n = 10, cholangiocarcinoma n = 2, mCRC n = 1) underwent RL prior to resection. The median time between RL and post-RL imaging was 40 days (23–190 days); the median time to resection was 86 days (30–210 days). Median FLR increased significantly [pre: 33% (22–43%); post: 43% (29–69%), P < 0.01] to yield a median %FLR hypertrophy of 30% (4–105%). The median hospital stay after resection was 4 days (3–11 days). Transient hepatobiliary toxicities normalized post-operatively. Ninety-two percent of resected tumors had >50% pathologic necrosis. Median follow up time after surgery was 604 days (144–1,416 days); one death occurred. Conclusions: In this preliminary study, radiation lobectomy was a safe and effective method to achieve remnant liver hypertrophy while providing tumor control. This approach may facilitate safe resection and favorable post-operative outcomes.J. Surg. Oncol. 2016;114:99–105.

KW - future liver remnant

KW - hepatectomy

KW - radioembolization

KW - resection

KW - yttrium-90

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U2 - 10.1002/jso.24269

DO - 10.1002/jso.24269

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JO - Journal of Surgical Oncology

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