title: Impact of prior hepatectomy on the safety and efficacy of radioembolization with yttrium-90 microspheres for patients with unresectable liver tumors.
abstract: OBJECTIVE
  Yttrium-90 (Y) radioembolization is increasingly used as a minimally invasive therapy for unresectable liver tumors; however, previous hepatectomy must be considered to avoid excessive hepatic insult. A retrospective analysis was undertaken to investigate the viability of performing radioembolization on a remnant liver.
  
  
  METHODS
  A retrospective analysis was performed on data collected from December 2005 to August 2011 to identify the effect of prior hepatectomy on radioembolization outcomes. Survival and complications were reviewed for up to 3 months after radioembolization.
  
  
  RESULTS
  Of 427 patients eligible for analysis, 89 underwent previous hepatectomy. Immediate adverse events included abdominal pain (7.9% of hepatectomy patients vs. 18.0% of non-hepatectomy patients; P = 0.02), nausea (4.5% vs. 8.0%; P > 0.05), and emesis (0.0% vs. 0.9%; P > 0.05). The prevalence of intermediate complications 1 month after radioembolization was low. Late complications included radiation-induced liver disease (3.4% vs. 1.5%; P > 0.05), ulceration (2.2% vs. 2.7%; P > 0.05), and gallbladder and biliary tree-related outcomes (2.2% vs. 1.8%; P > 0.05). Imaging analysis demonstrated a significant relationship between prior hepatectomy patients and a partial response to radioembolization, as well as progressive disease. The median overall survival after radioembolization for hepatectomy patients was 7.8 months, versus 5.8 months for non-hepatectomy patients (P = 0.108).
  
  
  CONCLUSIONS
  Our results indicate that radioembolization is safe to be performed on a remnant liver. Although imaging analysis demonstrated varying responses to radioembolization when comparing hepatectomy patients to non-hepatectomy patients, overall survival was shown to be similar between the 2 groups.
authors: *Department of Medical Imaging, St Vincent's Hospital ‡Department of Surgery, St George Hospital †Faculty of Medicine, University of New South Wales, Sydney, NSW Australia.
authors: Lourens
authors: L
authors: Bester
authors: Samantha
authors: S
authors: Feitelson
authors: Brad
authors: B
authors: Milner
authors: Terence C
authors: TC
authors: Chua
authors: David L
authors: DL
authors: Morris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000401:mortality / Q000628:therapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D015021:Yttrium Radioisotopes