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

Research output: Contribution to journalArticlepeer-review

71 Scopus citations

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
Externally publishedYes

Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Oncology

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