title: Cholecystitis after yttrium-90 resin microsphere radioembolization treatment: Clinical and pathologic findings.
abstract: BACKGROUND
  Radioembolization with yttrium microspheres is an established therapeutic modality for primary and secondary hepatic malignancies, with studies demonstrating improved overall survival. There remains a paucity of data on cholecystitis as a complication of radioembolization. We describe a small series of patients who developed cholecystitis as a result of radioembolization.
  
  
  METHODS
  Patients who had developed cholecystitis as a complication of radioembolization in our institution between 2001 and 2012 were retrospectively reviewed. Patient demographics, cancer details including treatment history, and procedural details of radioembolization and complications of cholecystitis were collected.
  
  
  RESULTS
  Of 74 patients who underwent radioembolization using yttrium-90emitting microspheres, four (5.4%) presented with acute cholecystitis as a result of their treatment. All patients presented over 4 weeks following radioembolization and did not settle with conservative treatment. At surgery, the gallbladder was fibrotic and contracted in all cases making surgery difficult.
  
  
  CONCLUSIONS
  The incidence of symptomatic radiation cholecystitis after radioembolization is low, and prophylactic cholecystectomy is not routinely recommended for patients undergoing radioembolization. Radiation cholecystitis should be suspected in patients presenting with symptoms of biliary colic or cholecystitis following radioembolization. Early cholecystectomy can be considered in patients undergoing surgery for other indications, especially in high-risk surgical patients in whom there is a high likelihood of radioembolization in the future as they do not respond to conservative treatment.
authors.affiliation: Department of Medical Oncology, The Canberra Hospital, Garran, ACT, Australia.
authors.forename: Sagun
authors.initials: S
authors.lastname: Parakh
authors.affiliation: Division of Surgery, The Canberra Hospital, Garran, ACT, Australia; ANU Medical School, Australian National University, Canberra, ACT, Australia.
authors.forename: Sivakumar
authors.initials: S
authors.lastname: Gananadha
authors.affiliation: Department of Medical Imaging, The Canberra Hospital, Garran, ACT, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Allen
authors.affiliation: Department of Medical Oncology, The Canberra Hospital, Garran, ACT, Australia; ANU Medical School, Australian National University, Canberra, ACT, Australia. Electronic address: desmond.yip@act.gov.au.
authors.forename: Desmond
authors.initials: D
authors.lastname: Yip
mesh_terms: D000328:Adult; D000368:Aged; D002763:Cholecystectomy; D041881:Cholecystitis, Acute / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D015021:Yttrium Radioisotopes / Q000009:adverse effects*
chemical_list: D015021:Yttrium Radioisotopes
keywords: cholecystectomy; gallbladder; interventional oncology; radioembolization; yttrium-90