(90) Y radiation lobectomy: Outcomes following surgical resection in patients with hepatic tumors and small future liver remnant volumes.
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. © 2016 Wiley Periodicals, Inc.
Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, Illinois.
Robert J
RJ
Lewandowski
Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, Illinois.
Larry
L
Donahue
Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois.
Attasit
A
Chokechanachaisakul
Division of Hepatology, Department of Medicine, Northwestern University, Chicago, Illinois.
Laura
L
Kulik
Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, Illinois.
Samdeep
S
Mouli
Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois.
Juan
J
Caicedo
Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois.
Michael
M
Abecassis
Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois.
Jonathan
J
Fryer
Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, Illinois.
Riad
R
Salem
Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois.
Talia
T
Baker
D000328:Adult; D000368:Aged; D018281:Cholangiocarcinoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008099:Liver / Q000473:pathology / Q000502:physiology / Q000601:surgery; D008113:Liver Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D008115:Liver Regeneration; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes
future liver remnant; hepatectomy; radioembolization; resection; yttrium-90