Liver Resection and Transplantation Following Yttrium-90 Radioembolization for Primary Malignant Liver Tumors: A 15-Year Single-Center Experience
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Patient Evaluation and Eligibility
2.1.1. Inclusion Criteria
2.1.2. Criteria for Considering Patients Unsuitable for LR or LT
2.1.3. Indications for Yttrium-90 Radioembolization
2.2. Yttrium-90 Radioembolization
2.2.1. Eligibility
- (a)
- A lung shunt fraction >20% or an estimated dose of radiation to the lungs > 30 Gy;
- (b)
- Previous stereotactic body radiation therapy to the liver;
- (c)
- Presence of collateral vessels feeding extrahepatic organs that cannot be corrected by angiographic techniques.
2.2.2. Radioembolization Protocol
2.3. Response to Radioembolization, Re-Evaluation, and Eligibility for Liver Resection or Transplantation
2.4. Surgical Outcomes
2.5. Data Collection
2.6. Statistical Analysis
3. Results
3.1. Radioembolization Characteristics and Outcomes
3.2. Surgical Outcomes
3.2.1. Liver Resection
3.2.2. Laparoscopic Liver Resection
3.2.3. Liver Transplantation
3.3. Postoperative Outcomes
3.3.1. Liver Resection
3.3.2. Liver Transplantation
3.4. Survival Analysis
3.4.1. Liver Resection
3.4.2. Liver Transplantation
4. Discussion
4.1. Liver Resection
4.1.1. Postoperative Outcomes
4.1.2. HCC Survival Outcomes
4.1.3. ICC Survival Outcomes
4.2. Liver Transplantation
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Whole Cohort (n = 34) | Resection (n = 21) | Transplantation (n = 13) | |
---|---|---|---|
Age (years) a | 64.7 (1.2) | 66.3 (1.1) | 62 (1.3) |
Sex (M:F) | 32:2 | 19:2 | 13:0 |
Tumor type | |||
HCC | 26 (76.4) | 13 (61.9) | 13 (100) |
ICC | 8 (23.6) | 8 (38.1) | 0 (0.0) |
BMI (kg/m2) a | 28.1 (0.7) | 27.4 (0.7) | 29.1 (1.2) |
ASA score b | 3 (2–4) | 3 (2–4) | 3 (3–4) |
Comorbidities | |||
Hypertension | 14 (41.2) | 12 (57.1) | 2 (15.4) |
Cardiopathy | 15 (44.1) | 8 (38.1) | 7 (53.8) |
Diabetes | 10 (29.4) | 5 (23.8) | 5 (38.5) |
COPD | 2 (5.9) | 2 (9.5) | 0 (0.0) |
Chronic renal injury | 4 (11.8) | 3 (14.3) | 1 (7.7) |
Prior abdominal surgery | 13 (38.2) | 10 (29.4) | 3 (23.1) |
Pre-operative tumor size (cm) a | 6.3 (0.7) | 8.2 (0.8) | 3.4 (1.4) |
Total bilirubin (mg/dl) b | 0.9 (0.4–6.8) | 0.7 (0.4–1.7) | 1.7 (0.5–6.8) |
Prior liver procedure | 8 (23.6) | 4 (19.0) | 4 (30.7) |
Resection | 0 (0.0) | 0 (0.0) | 0 (0.0) |
Ablation | 4 (11.8) | 2 (9.5) | 2 (15.4) |
Portal vein embolization | 2 (5.9) | 2 (9.5) | 0 (0.0) |
TACE | 2 (5.9) | 0 (0.0) | 2 (15.4) |
RE treatment | |||
Whole liver radiation | 3 (8.9) | 3 (14.3) | 0 (0.0) |
Lobar extended | 5 (14.7) | 4 (19.0) | 1 (7.7) |
Lobar | 13 (38.2) | 6 (28.6) | 7 (53.8) |
Segmental | 13 (38.2) | 8 (38.1) | 5 (38.5) |
Pre-RE systemic treatment + | 10 (29.4) | 10 (47.6) | 0 (0.0) |
Post-RE systemic treatment | 8 (23.5) | 8 (38.1) | 0 (0.0) |
HCC Cohort (n = 26) | Resection (n = 13) | Transplantation (n = 13) | |
---|---|---|---|
Cirrhosis (Child–Pugh) | 23 (88.5) | 10 (76.9) | 13 (100) |
Grade A | 20 (87.0) | 9 (90.0) | 11 (84.6) |
Grade B | 3 (13.0) | 1 (10.0) | 2 (15.4) |
Grade C | 0 (0.0) | 0 (0.0) | 0 (0.0) |
Staging BCLC | |||
BCLC A | 9 (34.6) | 2 (15.4) | 7 (53.8) |
BCLC B | 14 (53.8) | 8 (61.5) | 6 (46.2) |
BCLC C | 3 (11.5) | 3 (23.1) | 0 (0.0) |
Etiology of HCC | |||
Alcoholic cirrhosis | 9 (34.6) | 1 (7.7) | 8 (61.5) |
HCV | 8 (30.8) | 6 (46.2) | 2 (15.4) |
HBV | 2 (7.7) | 0 (0.0) | 2 (15.4) |
NASH | 1 (3.8) | 1 (7.7) | 0 (0.0) |
Hemochromatosis | 2 (7.7) | 2 (15.4) | 0 (0.0) |
Cryptogenic | 4 (15.4) | 3 (23.1) | 1 (7.7) |
Serum AFP (ng/mL) a | 5.99 (1.7–10659) | 2685 (1.8–10659) | 9.75 (1.7–805) |
Whole Cohort (n = 34) | Resected (n = 21) | Transplanted (n = 13) | |||
---|---|---|---|---|---|
Postoperative Outcomes | Whole | Open (n = 12) | LLR (n = 9) | ||
Hospital stay (day) a | 6 (3–17) | 5 (3–17) | 9.5 (4–17) | 3.5 (3–11) | 6 (5–16) |
Overall complication | 13 (38.2) | 9 (42.9) | 6 (50.0) | 3 (33.3) | 4 (30.8) |
Clavien–Dindo III-IV | 5 (14.7) | 4 (19.0) | 2 (16.7) | 2 (22.2) | 1 (7.7) |
PHLF (ISGLS) | |||||
PHLF C | 1 (2.9) | 1 (4.8) | 1 (4.8) | 0 (0.0) | 0 (0.0) |
PHH (ISGLS) | |||||
PHH C | 1 (2.9) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 1 (7.7) |
Bile leakage (≥grade B) (ISGLS) | 3 (8.8) | 3 (14.3) | 2 (16.7) | 1 (11.1) | 0 (0.0) |
Re-operation | 2 (5.9) | 1 (4.8) | 0 (0.0) | 1 (11.1) | 1 (7.7) |
90 days readmission | 4 (11.8) | 2 (9.5) | 1 (4.8) | 1 (11.1) | 2 (15.4) |
90 days mortality | 2 (5.9) | 2 (9.5) | 2 (16.7) | 0 (0.0) | 0 (0.0) |
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Aliseda, D.; Martí-Cruchaga, P.; Zozaya, G.; Rodríguez-Fraile, M.; Bilbao, J.I.; Benito-Boillos, A.; Martínez De La Cuesta, A.; Lopez-Olaondo, L.; Hidalgo, F.; Ponz-Sarvisé, M.; et al. Liver Resection and Transplantation Following Yttrium-90 Radioembolization for Primary Malignant Liver Tumors: A 15-Year Single-Center Experience. Cancers 2023, 15, 733. https://doi.org/10.3390/cancers15030733
Aliseda D, Martí-Cruchaga P, Zozaya G, Rodríguez-Fraile M, Bilbao JI, Benito-Boillos A, Martínez De La Cuesta A, Lopez-Olaondo L, Hidalgo F, Ponz-Sarvisé M, et al. Liver Resection and Transplantation Following Yttrium-90 Radioembolization for Primary Malignant Liver Tumors: A 15-Year Single-Center Experience. Cancers. 2023; 15(3):733. https://doi.org/10.3390/cancers15030733
Chicago/Turabian StyleAliseda, Daniel, Pablo Martí-Cruchaga, Gabriel Zozaya, Macarena Rodríguez-Fraile, José I. Bilbao, Alberto Benito-Boillos, Antonio Martínez De La Cuesta, Luis Lopez-Olaondo, Francisco Hidalgo, Mariano Ponz-Sarvisé, and et al. 2023. "Liver Resection and Transplantation Following Yttrium-90 Radioembolization for Primary Malignant Liver Tumors: A 15-Year Single-Center Experience" Cancers 15, no. 3: 733. https://doi.org/10.3390/cancers15030733