The Safety of Resection Post-Selective Internal Radiation Therapy

Rotellar, Fernando; Pardo, Fernando; Martínez-Ortega, Patricia

doi:10.2217/fon.14.224

Cited by 5 publications

(3 citation statements)

References 7 publications

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“…If we look at the distribution over time, between 2011 and 2014, 8 liver resections were performed after RE in our center: 6 were open surgery (75%) and 2 laparoscopic (25%) (one of them a major resection). After this first major resection in 2014 (to our knowledge, the first major resection post RE published in the literature [ 16 ]), in the next period, this was our preferred approach. From 2015 to 2020, 13 liver resections were performed after RE: 10 of them laparoscopic (77%) and only 3 open (23%).…”

Section: Discussionmentioning

confidence: 99%

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

Aliseda

Martí‐Cruchaga

Zozaya

et al. 2022

Langenbecks Arch Surg

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Background Liver surgery after radioembolization (RE) entails highly demanding and challenging procedures due to the frequent combination of large tumors, severe RE-related adhesions, and the necessity of conducting major hepatectomies. Laparoscopic liver resection (LLR) and its associated advantages could provide benefits, as yet unreported, to these patients. The current study evaluated feasibility, morbidity, mortality, and survival outcomes for major laparoscopic liver resection after radioembolization. Material and methods In this retrospective, single-center study patients diagnosed with hepatocellular carcinoma, intrahepatic cholangiocarcinoma or metastases from colorectal cancer undergoing major laparoscopic hepatectomy after RE were identified from institutional databases. They were matched (1:2) on several pre-operative characteristics to a group of patients that underwent major LLR for the same malignancies during the same period but without previous RE. Results From March 2011 to November 2020, 9 patients underwent a major LLR after RE. No differences were observed in intraoperative blood loss (50 vs. 150 ml; p = 0.621), operative time (478 vs. 407 min; p = 0.135) or pedicle clamping time (90.5 vs 74 min; p = 0.133) between the post-RE LLR and the matched group. Similarly, no differences were observed on hospital stay (median 3 vs. 4 days; p = 0.300), Clavien–Dindo ≥ III complications (2 vs. 1 cases; p = 0.250), specific liver morbidity (1 vs. 1 case p = 1.000), or 90 day mortality (0 vs. 0; p = 1.000). Conclusion The laparoscopic approach for post radioembolization patients may be a feasible and safe procedure with excellent surgical and oncological outcomes and meets the current standards for laparoscopic liver resections. Further studies with larger series are needed to confirm the results herein presented.

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Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Aliseda

Martí‐Cruchaga

Zozaya

et al. 2022

Langenbecks Arch Surg

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“…Due to the short effective distance of the microspheres and portal venous blood supply, normal hepatic parenchyma should be relatively spared from the Y90 microsphere's radiotherapy effect [14]. Surgical resectability is determined by the ability to safely achieve a surgical margin (R0) while preserving a residual adequate liver volume ((FLR) future liver remnant), typically 25-30% of a healthy liver, but can increase up to 40% in patients with cirrhosis or after significant doses of chemotherapy [15]. If the FLR is the limiting factor for resection but is tumor free, portal vein embolization (PVE) can be considered to increase FLR.…”

Section: Discussionmentioning

confidence: 99%

Liver Resection After Selective Internal Radiation Therapy with Yttrium-90: Safety and Outcomes

Mafeld

Littler

Hayhurst

et al. 2019

J Gastrointest Canc

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Introduction Selective internal radiotherapy (SIRT) with yttrium-90 (Y-90) is an intra-arterial therapy for hepatic malignancy in patients who are unsuitable for surgical resection. This treatment is considered palliative, although some patients can demonstrate a response that is adequate to facilitate surgical resection with curative intent. Methods All patients who underwent liver resection post SIRT were reviewed. Data gathered included patient demographics, tumor type, surgical details, and post-operative outcomes. Results Twelve patients underwent SIRT followed by liver resection (7 males and 5 females). Pathologies were hepatocellular carcinoma (n = 5), metastatic colorectal cancer (n = 5), and neuroendocrine tumor (n = 2). Lesional response (size, volume, and RECIST (response evaluation criteria in solid tumors)) was calculated and where appropriate functional liver remnant (FLR) is presented. Mean FLR increase was 264cm 3 (range − 123 to 909), and all cases demonstrated a partial response according to RECIST with a mean largest lesion volume reduction of 475cm 3 (range 14-1632). No post-SIRT complications were noted. Hepatectomy occurred at a mean of 322 days from SIRT treatment. Ninety-day morbidity was 67% (n = 6), complications postsurgery were analyzed according to the Clavien-Dindo classification scale; a total of 15 events occurred in 6 patients. Ninety-day mortality of 11% (n = 1). Conclusion In selected cases, liver resection is possible post SIRT. As this can represent a potentially curative option, it is important to reconsider resection in the follow-up of patients undergoing SIRT. Post-operative complications are noted following major and extended liver resection. Therefore, further studies are needed to improve patient selection.

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