Pure laparoscopic major liver resection after yttrium
Colorectal liver metastases
Hepatocellular carcinoma
Intrahepatic cholangiocarcinoma
Laparoscopic liver resection
Radioembolization
Journal
Langenbeck's archives of surgery
ISSN: 1435-2451
Titre abrégé: Langenbecks Arch Surg
Pays: Germany
ID NLM: 9808285
Informations de publication
Date de publication:
May 2022
May 2022
Historique:
received:
14
09
2021
accepted:
15
02
2022
pubmed:
2
3
2022
medline:
3
6
2022
entrez:
1
3
2022
Statut:
ppublish
Résumé
Liver surgery after radioembolization (RE) entails highly demanding and challenging procedures due to the frequent combination of large tumors, severe RE-related adhesions, and the necessity of conducting major hepatectomies. Laparoscopic liver resection (LLR) and its associated advantages could provide benefits, as yet unreported, to these patients. The current study evaluated feasibility, morbidity, mortality, and survival outcomes for major laparoscopic liver resection after radioembolization. In this retrospective, single-center study patients diagnosed with hepatocellular carcinoma, intrahepatic cholangiocarcinoma or metastases from colorectal cancer undergoing major laparoscopic hepatectomy after RE were identified from institutional databases. They were matched (1:2) on several pre-operative characteristics to a group of patients that underwent major LLR for the same malignancies during the same period but without previous RE. From March 2011 to November 2020, 9 patients underwent a major LLR after RE. No differences were observed in intraoperative blood loss (50 vs. 150 ml; p = 0.621), operative time (478 vs. 407 min; p = 0.135) or pedicle clamping time (90.5 vs 74 min; p = 0.133) between the post-RE LLR and the matched group. Similarly, no differences were observed on hospital stay (median 3 vs. 4 days; p = 0.300), Clavien-Dindo ≥ III complications (2 vs. 1 cases; p = 0.250), specific liver morbidity (1 vs. 1 case p = 1.000), or 90 day mortality (0 vs. 0; p = 1.000). The laparoscopic approach for post radioembolization patients may be a feasible and safe procedure with excellent surgical and oncological outcomes and meets the current standards for laparoscopic liver resections. Further studies with larger series are needed to confirm the results herein presented.
Sections du résumé
BACKGROUND
BACKGROUND
Liver surgery after radioembolization (RE) entails highly demanding and challenging procedures due to the frequent combination of large tumors, severe RE-related adhesions, and the necessity of conducting major hepatectomies. Laparoscopic liver resection (LLR) and its associated advantages could provide benefits, as yet unreported, to these patients. The current study evaluated feasibility, morbidity, mortality, and survival outcomes for major laparoscopic liver resection after radioembolization.
MATERIAL AND METHODS
METHODS
In this retrospective, single-center study patients diagnosed with hepatocellular carcinoma, intrahepatic cholangiocarcinoma or metastases from colorectal cancer undergoing major laparoscopic hepatectomy after RE were identified from institutional databases. They were matched (1:2) on several pre-operative characteristics to a group of patients that underwent major LLR for the same malignancies during the same period but without previous RE.
RESULTS
RESULTS
From March 2011 to November 2020, 9 patients underwent a major LLR after RE. No differences were observed in intraoperative blood loss (50 vs. 150 ml; p = 0.621), operative time (478 vs. 407 min; p = 0.135) or pedicle clamping time (90.5 vs 74 min; p = 0.133) between the post-RE LLR and the matched group. Similarly, no differences were observed on hospital stay (median 3 vs. 4 days; p = 0.300), Clavien-Dindo ≥ III complications (2 vs. 1 cases; p = 0.250), specific liver morbidity (1 vs. 1 case p = 1.000), or 90 day mortality (0 vs. 0; p = 1.000).
CONCLUSION
CONCLUSIONS
The laparoscopic approach for post radioembolization patients may be a feasible and safe procedure with excellent surgical and oncological outcomes and meets the current standards for laparoscopic liver resections. Further studies with larger series are needed to confirm the results herein presented.
Identifiants
pubmed: 35229168
doi: 10.1007/s00423-022-02474-z
pii: 10.1007/s00423-022-02474-z
pmc: PMC9151566
doi:
Substances chimiques
Yttrium
58784XQC3Y
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1099-1111Informations de copyright
© 2022. The Author(s).
Références
Sangro B, Bilbao JI, Boan J et al (2006) Radioembolization using 90Y-resin microspheres for patients with advanced hepatocellular carcinoma. Int J Radiat Oncol Biology Phys 66:792–800. https://doi.org/10.1016/j.ijrobp.2006.05.065
doi: 10.1016/j.ijrobp.2006.05.065
Riby D, Mazzotta AD, Bergeat D et al (2020) Downstaging with Radioembolization or Chemotherapy for initially unresectable intrahepatic cholangiocarcinoma. Ann Surg Oncol 27:3729–3737. https://doi.org/10.1245/s10434-020-08486-7
doi: 10.1245/s10434-020-08486-7
pubmed: 32472411
Iñarrairaegui M, Pardo F, Bilbao JI et al (2012) Response to radioembolization with yttrium-90 resin microspheres may allow surgical treatment with curative intent and prolonged survival in previously unresectable hepatocellular carcinoma. European J Surg Oncol Ejso 38:594–601. https://doi.org/10.1016/j.ejso.2012.02.189
doi: 10.1016/j.ejso.2012.02.189
Garlipp B, Gibbs P, Hazel GAV et al (2019) Secondary technical resectability of colorectal cancer liver metastases after chemotherapy with or without selective internal radiotherapy in the randomized SIRFLOX trial. Brit J Surg 106:1837–1846. https://doi.org/10.1002/bjs.11283
doi: 10.1002/bjs.11283
pubmed: 31424576
Gaba RC, Lewandowski RJ, Kulik LM et al (2009) Radiation lobectomy: preliminary findings of hepatic volumetric response to lobar yttrium-90 radioembolization. Ann Surg Oncol 16:1587–1596. https://doi.org/10.1245/s10434-009-0454-0
doi: 10.1245/s10434-009-0454-0
pubmed: 19357924
Fernandez-Ros N, Iñarrairaegui M, Paramo JA et al (2015) Radioembolization of hepatocellular carcinoma activates liver regeneration, induces inflammation and endothelial stress and activates coagulation. Liver Int 35:1590–1596. https://doi.org/10.1111/liv.12592
doi: 10.1111/liv.12592
pubmed: 24836705
Fernández-Ros N, Silva N, Bilbao JI et al (2014) Partial liver volume radioembolization induces hypertrophy in the spared hemiliver and no major signs of portal hypertension. HPB 16:243–249. https://doi.org/10.1111/hpb.12095
doi: 10.1111/hpb.12095
pubmed: 23530966
Jakobs TF, Saleem S, Atassi B et al (2008) Fibrosis, portal hypertension, and hepatic volume changes induced by intra-arterial radiotherapy with 90Yttrium microspheres. Digest Dis Sci 53:2556–2563. https://doi.org/10.1007/s10620-007-0148-z
doi: 10.1007/s10620-007-0148-z
pubmed: 18231857
Chua TC, Bester L, Akther J, Morris DL (2010) Successful right hepatectomy after four treatments of yttrium-90 microspheres (SIR-Spheres) and concomitant FOLFOX as bridging therapy to resection of colorectal liver metastases. Anticancer Res 30:3005–3007
pubmed: 20683046
Gulec SA, Pennington K, Hall M, Fong Y (2009) Preoperative Y-90 microsphere selective internal radiation treatment for tumor downsizing and future liver remnant recruitment: a novel approach to improving the safety of major hepatic resections. World J Surg Oncol 7:6–6. https://doi.org/10.1186/1477-7819-7-6
doi: 10.1186/1477-7819-7-6
pubmed: 19133156
pmcid: 2655298
Justinger C, Kouladouros K, Gärtner D et al (2015) Liver resection after selective internal radiotherapy (SIRT): proof of concept, initial survival, and safety. J Surg Oncol 112:436–442. https://doi.org/10.1002/jso.24000
doi: 10.1002/jso.24000
pubmed: 26256832
Pardo F, Sangro B, Lee R-C et al (2017) The Post-SIR-Spheres Surgery Study (P4S): retrospective analysis of safety following hepatic resection or transplantation in patients previously treated with selective internal radiation therapy with yttrium-90 resin microspheres. Ann Surg Oncol 24:2465–2473. https://doi.org/10.1245/s10434-017-5950-z
doi: 10.1245/s10434-017-5950-z
pubmed: 28653161
Noda C, Williams GA, Foltz G et al (2020) The safety of hepatectomy after transarterial radioembolization: single institution experience and review of the literature. J Surg Oncol. https://doi.org/10.1002/jso.26115
doi: 10.1002/jso.26115
pubmed: 32662066
pmcid: 7855767
Ahmed A, Stauffer JA, LeGout JD, et al (2021) The use of neoadjuvant lobar radioembolization prior to major hepatic resection for malignancy results in a low rate of post hepatectomy liver failure. J Gastrointest Oncol 12:751–761. https://doi.org/10.21037/jgo-20-507
Rotellar F, Zozaya G, Martí-Cruchaga P, Pardo F (2017) Laparoscopic right hepatectomy after radioembolization using yttrium-90 resin microspheres. Surg Oncol 26:71–72. https://doi.org/10.1016/j.suronc.2016.12.004
doi: 10.1016/j.suronc.2016.12.004
pubmed: 32046821
Rotellar F, Pardo F, Martnez-Ortega P (2014) The safety of resection post-selective internal radiation therapy. Future Oncol 10:53–55. https://doi.org/10.2217/fon.14.224
doi: 10.2217/fon.14.224
pubmed: 25478768
Görgec B, Cacciaguerra AB, Lanari J et al (2021) Assessment of textbook outcome in laparoscopic and open liver surgery. Jama Surg 156:e212064. https://doi.org/10.1001/jamasurg.2021.2064
doi: 10.1001/jamasurg.2021.2064
pubmed: 34076671
pmcid: 8173471
Gil-Alzugaray B, Chopitea A, Iñarrairaegui M et al (2013) Prognostic factors and prevention of radioembolization-induced liver disease. Hepatology 57:1078–1087. https://doi.org/10.1002/hep.26191
doi: 10.1002/hep.26191
pubmed: 23225191
Sirtex Medical. SIR-Spheres® Y-90 resin microspheres activity chart (2020); Available from: https://www.sirtex.com/media/168731/activity-chart-apm-us-368-v1-0220.pdf . Accesed 20 Oct 2021
Washington, Services UD of H and H, Health NI of, Institute NC (2018) National Institutes of Health. Common terminology criteria for adverse events (CTCAE) version 5.0. Available from: https://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm#ctc_50 . Accesed 20 Oct 2021
Wakabayashi G (2016) What has changed after the Morioka consensus conference 2014 on laparoscopic liver resection? Hepatobiliary Surg Nutrition 5:281–289. https://doi.org/10.21037/hbsn.2016.03.03
Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications. Ann Surg 240:205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae
doi: 10.1097/01.sla.0000133083.54934.ae
pubmed: 15273542
pmcid: 1360123
Halls MC, Berardi G, Cipriani F et al (2018) Development and validation of a difficulty score to predict intraoperative complications during laparoscopic liver resection. Brit J Surg 105:1182–1191. https://doi.org/10.1002/bjs.10821
doi: 10.1002/bjs.10821
pubmed: 29737513
Rahbari NN, Garden OJ, Padbury R et al (2011) Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery 149:713–724. https://doi.org/10.1016/j.surg.2010.10.001
doi: 10.1016/j.surg.2010.10.001
pubmed: 21236455
Rahbari NN, Garden OJ, Padbury R et al (2011) Post-hepatectomy haemorrhage: a definition and grading by the International Study Group of Liver Surgery (ISGLS). HPB 13:528–535. https://doi.org/10.1111/j.1477-2574.2011.00319.x
doi: 10.1111/j.1477-2574.2011.00319.x
pubmed: 21762295
pmcid: 3163274
Rotellar F, Martí-Cruchaga P, Zozaya G et al (2020) Caudal approach to the middle hepatic vein as a resection pathway in difficult major hepatectomies under laparoscopic approach. J Surg Oncol 122:1426–1427. https://doi.org/10.1002/jso.26150
doi: 10.1002/jso.26150
pubmed: 32748420
Rotellar F, Pardo F, Benito A et al (2014) Laparoscopic right hepatectomy extended to middle hepatic vein after right portal vein embolization. Ann Surg Oncol 21:165–166. https://doi.org/10.1245/s10434-013-3298-6
doi: 10.1245/s10434-013-3298-6
pubmed: 24081808
Rotellar F, Pardo F, Bueno A et al (2012) Extracorporeal tourniquet method for intermittent hepatic pedicle clamping during laparoscopic liver surgery: an easy, cheap, and effective technique. Langenbeck’s Archives Surg 397:481–485. https://doi.org/10.1007/s00423-011-0887-3
doi: 10.1007/s00423-011-0887-3
Rotellar F, Pardo F, Martí-Cruchaga P et al (2017) Liver mobilization and liver hanging for totally laparoscopic right hepatectomy: an easy way to do it. Langenbeck’s Archives Surg 402:181–185. https://doi.org/10.1007/s00423-016-1473-5
doi: 10.1007/s00423-016-1473-5
Rotellar F, Pardo F, Benito A et al (2012) A novel extra-glissonian approach for totally laparoscopic left hepatectomy. Surg Endosc 26:2617–2622. https://doi.org/10.1007/s00464-012-2242-3
doi: 10.1007/s00464-012-2242-3
pubmed: 22447286
Rotellar F, Martí-Cruchaga P, Zozaya G et al (2020) Standardized laparoscopic central hepatectomy based on hilar caudal view and root approach of the right hepatic vein. J Hepato Biliary Pancreat Sci 27:E7–E8. https://doi.org/10.1002/jhbp.669
doi: 10.1002/jhbp.669
Liver EA for the S of the, Galle PR, Forner A et al (2018) EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 69:182–236. https://doi.org/10.1016/j.jhep.2018.03.019
doi: 10.1016/j.jhep.2018.03.019
Banales JM, Marin JJG, Lamarca A et al (2020) Cholangiocarcinoma 2020: the next horizon in mechanisms and management. Nat Rev Gastroentero 17:557–588. https://doi.org/10.1038/s41575-020-0310-z
doi: 10.1038/s41575-020-0310-z
Cutsem EV, Cervantes A, Adam R et al (2016) ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol 27:1386–1422. https://doi.org/10.1093/annonc/mdw235
doi: 10.1093/annonc/mdw235
pubmed: 27380959
Al-Adra DP, Gill RS, Axford SJ et al (2015) Treatment of unresectable intrahepatic cholangiocarcinoma with yttrium-90 radioembolization: a systematic review and pooled analysis. European J Surg Oncol Ejso 41:120–127. https://doi.org/10.1016/j.ejso.2014.09.007
doi: 10.1016/j.ejso.2014.09.007
Lewandowski RJ, Kulik LM, Riaz A et al (2009) A comparative analysis of transarterial downstaging for hepatocellular carcinoma: chemoembolization versus radioembolization. Am J Transplant 9:1920–1928. https://doi.org/10.1111/j.1600-6143.2009.02695.x
doi: 10.1111/j.1600-6143.2009.02695.x
pubmed: 19552767
Kulik LM, Carr BI, Mulcahy MF et al (2008) Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis. Hepatology 47:71–81. https://doi.org/10.1002/hep.21980
doi: 10.1002/hep.21980
pubmed: 18027884
Iñarrairaegui M, Martinez-Cuesta A, Rodríguez M et al (2010) Analysis of prognostic factors after yttrium-90 radioembolization of advanced hepatocellular carcinoma. Int J Radiat Oncol Biology Phys 77:1441–1448. https://doi.org/10.1016/j.ijrobp.2009.07.006
doi: 10.1016/j.ijrobp.2009.07.006
Petrowsky H, Fritsch R, Guckenberger M et al (2020) Modern therapeutic approaches for the treatment of malignant liver tumours. Nat Rev Gastroentero 17:755–772. https://doi.org/10.1038/s41575-020-0314-8
doi: 10.1038/s41575-020-0314-8
Petrowsky H, Linecker M, Raptis DA et al (2020) First long-term oncologic results of the ALPPS procedure in a large cohort of patients with colorectal liver metastases. Ann Surg 272:793–800. https://doi.org/10.1097/sla.0000000000004330
doi: 10.1097/sla.0000000000004330
pubmed: 32833765
Fretland ÅA, Dagenborg VJ, Bjørnelv GMW et al (2018) Laparoscopic versus open resection for colorectal liver metastases. Ann Surg 267:199–207. https://doi.org/10.1097/sla.0000000000002353
doi: 10.1097/sla.0000000000002353
pubmed: 28657937
Xie S-M, Xiong J-J, Liu X-T et al (2017) Laparoscopic versus open liver resection for colorectal liver metastases: a comprehensive systematic review and meta-analysis. Sci Rep-uk 7:1012. https://doi.org/10.1038/s41598-017-00978-z
doi: 10.1038/s41598-017-00978-z
Dorcaratto D, Mazzinari G, Fernandez M, et al (2019) Impact of postoperative complications on survival and recurrence after resection of colorectal liver metastases. Ann Surg Publish Ahead of Print:NA; https://doi.org/10.1097/sla.0000000000003254
Melandro F, Giovanardi F, Hassan R et al (2019) Minimally invasive approach in the setting of ALPPS procedure: a systematic review of the literature. J Gastrointest Surg 23:1917–1924. https://doi.org/10.1007/s11605-018-04092-x
doi: 10.1007/s11605-018-04092-x
pubmed: 31197682
Okumura S, Goumard C, Gayet B et al (2019) Laparoscopic versus open two-stage hepatectomy for bilobar colorectal liver metastases: a bi-institutional, propensity score-matched study. Surgery 166:959–966. https://doi.org/10.1016/j.surg.2019.06.019
doi: 10.1016/j.surg.2019.06.019
pubmed: 31395397
Merath K, Chen Q, Bagante F et al (2019) A multi-institutional international analysis of textbook outcomes among patients undergoing curative-intent resection of intrahepatic cholangiocarcinoma. Jama Surg 154:e190571. https://doi.org/10.1001/jamasurg.2019.0571
doi: 10.1001/jamasurg.2019.0571
pubmed: 31017645
pmcid: 6487899
Tsilimigras DI, Sahara K, Moris D et al (2020) Assessing textbook outcomes following liver surgery for primary liver cancer over a 12-year time period at major hepatobiliary centers. Ann Surg Oncol 27:3318–3327. https://doi.org/10.1245/s10434-020-08548-w
doi: 10.1245/s10434-020-08548-w
pubmed: 32388742