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The safety and efficacy of liver resection after Y-90 radioembolization remains controversial. This study aims to investigate the clinical, surgical and pathological outcomes of patients who underwent liver resection after Y-90 radioembolization for the treatment of hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC) or liver metastases in a contemporary clinical practice. Single-institution review was performed of all patients who underwent hepatic resection or liver transplant after Y-90 radioembolization between January 2019 and July 2023. Patient charts and imaging were reviewed to collect baseline demographics, disease and treatment data, and pathological explant data. The primary endpoints were surgical resection margins, pathological necrosis, and overall survival. Twenty-three patients (7 women, 16 men, mean age 62 ± 10 years) met inclusion for the study. Only 14/23 (61%) patients had underlying liver disease due to one or more of: alcohol (n=2), hepatitis C (n=5), hepatitis B (n=1), and non-alcoholic fatty liver disease (n=6). Tumors included HCC (n=15), ICC (n=6), and metastatic disease (n=2). ECOG performance status was 0 (n=21) or 1 (n=3). Treated tumors (average size 6.5 ± 4.3 cm) were in the left (n = 4) or right hepatic lobe (n = 20). Y-90 treatment was lobar (n=9), segmental (n=2), or lobar with segmental boost (n=12). The average lobar dose administered was 195 ± 77 Gy and the average segmental dose was 195 ± 94 Gy. Average time to resection post Y-90 treatment was 145 ± 98 days). All patients underwent successful transplant (n=9), right (n=7), extended right (n=6), or extended left (n=1) hepatectomies. Only one patient had a positive resection margin near the hepatic vein margin, otherwise all others were R0 resections. 11/23 (48%) patients had 95-100% necrosis, 13/23 (56%) patients had at least 90% necrosis on explant pathology. No mortality occurred after transplant. Mortality after surgical resection at 30-days was 1/14 (7%), and 90-days was 3/14 (21%). Overall survival after surgical resection or transplant was 4/23 (17%) over a cumulative follow-up time of 37 patient years. No major Y-90 procedure complications or biochemical toxicities occurred. Hepatic resection and transplant after Y-90 can be safe and effective with high long-term overall survival. This was seen in a population of large tumors (average size 6.5 ±4.3 cm) and high lobar Y-90 dose (average 195 Gy), often with a boost dose to the tumor (average 195 Gy). Substantial tumor necrosis rates were seen with this Y-90 dosing.
Malavia et al. (Wed,) studied this question.