title: Liver Resection After Selective Internal Radiation Therapy with Yttrium-90 is Safe and Feasible: A Bi-institutional Analysis.
abstract: BACKGROUND
  Treatment with yttrium-90 (Y90) microspheres has emerged as a viable liver-directed therapy for patients with unresectable tumors and those outside transplantation criteria. A select number of patients demonstrate a favorable response and become candidates for surgical resection.
  
  
  METHODS
  Patients who underwent selective internal radiation therapy (SIRT) with Y90 microspheres at two institutions were reviewed. Patients who underwent liver resection were included in the study. The data gathered included demographics, tumor characteristics, response to Y90, surgical details, perioperative outcomes, and survival.
  
  
  RESULTS
  The inclusion criteria were met by 12 patients. The diagnoses included metastatic disease from colorectal adenocarcinoma (n = 6), neuroendocrine tumor (n = 1), and ocular melanoma (n = 1) in addition to hepatocellular carcinoma (n = 4). The median time from liver disease diagnosis to Y90 treatment was 5.5 months (range 2-92 months). The median time from Y90 treatment to surgery was 9.5 months (range 3-20 months). The surgical approach included right hepatectomy (n = 3), extended right hepatectomy (n = 5), extended left hepatectomy (n = 1), segmentectomy with ablation (n = 2), and segmentectomy with isolated liver perfusion (n = 1). The hospital stay was 7 days (range 4-31 days), and 67% of the patients were discharged home. The readmission rate was 42%. The 90-day morbidity and mortality rates were respectively 42 and 8%. At this writing, the median overall survival has not been reached at 25 months.
  
  
  CONCLUSIONS
  Liver resection after Y90 SIRT is a challenging surgical procedure with high rates of perioperative morbidity and hospital readmission. However, for properly selected patients, potential exists for extending disease-free and overall survival in the current era of multimodal therapy for malignant liver disease.
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. wrightgp@upmc.edu.
authors.forename: G Paul
authors.initials: GP
authors.lastname: Wright
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: J Wallis
authors.initials: JW
authors.lastname: Marsh
authors.affiliation: Advanced Radiology Services PC, Grand Rapids, MI, USA.
authors.forename: Manish K
authors.initials: MK
authors.lastname: Varma
authors.affiliation: Advanced Radiology Services PC, Grand Rapids, MI, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Doherty
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Bartlett
authors.affiliation: Division of Surgical Oncology, Spectrum Health Medical Group, Grand Rapids, MI, USA.|Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
authors.forename: Mathew H
authors.initials: MH
authors.lastname: Chung
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary / Q000628:therapy*; D000328:Adult; D000368:Aged; D001918:Brachytherapy; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D015179:Colorectal Neoplasms / Q000473:pathology*; D004621:Embolization, Therapeutic; D005134:Eye Neoplasms / Q000473:pathology; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000628:therapy*; D008545:Melanoma / Q000556:secondary; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000556:secondary; D010359:Patient Readmission; D011183:Postoperative Complications / Q000209:etiology; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D066066:Response Evaluation Criteria in Solid Tumors; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D015021:Yttrium Radioisotopes / Q000627:therapeutic use
chemical_list: D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes