The safety of hepatectomy after transarterial radioembolization: Single institution experience and review of the literature

Abstract

Background and Objectives: The liver is a frequent site of malignancy, both primary and metastatic. The treatment goal of patients with liver cancer may include transarterial radioembolization (TARE). There are limited reports on the safety of hepatectomy following TARE. Our study's purpose is to review patients who have received TARE followed by hepatectomy. Methods: A retrospective study was performed on patients diagnosed with any liver cancer from 2013 to 2019 who underwent TARE followed by hepatectomy. Postoperative complications were prospectively collected. Descriptive statistics and the Kaplan-Meier test were used to assess survival outcomes. Results: Twelve patients were treated with a TARE followed by a hepatectomy (nine with ≥4 segments resected). Diagnoses included: six HCC, four cholangiocarcinoma, one metastatic neuroendocrine tumor, and one metastatic colorectal cancer. There were no 90-day post-hepatectomy mortalities and the overall morbidity was 66% (16% severe ≥MAGS 3). Hepatectomy-specific complications after hepatectomy included two (16%) bile leaks and no post-hepatectomy liver failures. The median recurrence free survival was 26 months. Overall survival at 1-year was 78% and at 3 years was 47%. Conclusions: Our results support the safety of hepatectomy in select patients after TARE. Additional comparison to patients who receive hepatectomy as a first-line treatment for liver cancers should be investigated.

Pure laparoscopic major liver resection after yttrium90 radioembolization: a case-matched series analysis of feasibility and outcomes

“…Secondly, major LLR after RE should be performed by a highly experienced laparoscopic liver surgeon. According to the IWATE score [21], median difficulty of LLRs in this MLLR-RE series was 10 (8-11) and the risk of intra-operative events [23] was 9 (9)(10)(11)(12)(13)(14). This represents an expert level of difficulty and a high/extremely high risk of intra-operative complications.…”

“…However, perioperative surgical outcomes after RE were unknown until the multicenter Post-SIR-Spheres Surgery Study (P4S) [12] reported the adequate safety of open resection and transplantation after RE. Various articles have been published afterwards showing the outcomes of liver resection after RE [13,14]. Although laparoscopic liver resections (LLRs) have become increasingly widespread worldwide with an increasing number of reported cases, only a few preliminary results from our own experience of LLR post-RE have been reported [15,16].…”