Background:While preliminary reports on resection following downstaging using transarterial radioembolization(TARE)for intermediate or advanced hepatocellular carcinomas(HCCs)reported promising oncological outcomes,th...Background:While preliminary reports on resection following downstaging using transarterial radioembolization(TARE)for intermediate or advanced hepatocellular carcinomas(HCCs)reported promising oncological outcomes,there’s a notable gap in the literature concerning post operative morbidity.Contrary to post hepatectomy liver failure(PHLF),damages to the bile ducts and their potential consequences have been poorly evaluated.Thus,our aim was to explore postoperative complications in HCC patients undergoing liver resection after Y90 TARE,focusing particularly on biliary complications.Methods:Conducted from June 2015 to December 2022,this retrospective study involved 30 HCC patients undergoing liver resection post-TARE.Comprehensive data on surgical procedures,complications,and follow-up were collected.Logistic regression analyses were conducted,starting with univariate analysis followed by multivariate analysis,focusing on variables with a significance level below P<0.2.Results:The objective response rate(ORR)in the TARE-treated area was 97%at 3 months.Survival outcomes showed a median overall survival(OS)of 5.1 years and progression-free survival(PFS)of 3.5 years post-liver resection.The study found a 40%(12 out of 30 patients)rate of severe postoperative complications and a 7%(2 out of 30 patients)90-day mortality rate.After liver resection,grade B bile leaks occurred in 20%(6 out of 30)of patients,with a third experiencing recurrence.Biliary-specific mortality was 9%.After multivariate analysis,only the interval between TARE and surgery emerged a significant risk factor for biliary complications,showing increased odds of bile leaks if surgery occurred 3-6 months post-TARE compared to after 6 months.Conclusions:This study highlights the importance of timing between TARE and surgery,suggesting a waiting period of at least 6 months.Such timing not only enhances the radiation effects of TARE but also optimizes both future liver remnant growth and patient selection.展开更多
Background:We previously showed that embolization of portal inflow and hepatic vein(HV)outflow(liver venous deprivation,LVD)promotes future liver remnant(FLR)volume(FLR-V)and function(FLR-F)gain.Here,we compared FLR-V...Background:We previously showed that embolization of portal inflow and hepatic vein(HV)outflow(liver venous deprivation,LVD)promotes future liver remnant(FLR)volume(FLR-V)and function(FLR-F)gain.Here,we compared FLR-V and FLR-F changes after portal vein embolization(PVE)and LVD.Methods:This study included all patients referred for liver preparation before major hepatectomy over 26 months.Exclusion criteria were:unavailable baseline/follow-up imaging,cirrhosis,Klatskin tumor,two-stage hepatectomy.99mTc-mebrofenin SPECT-CT was performed at baseline and at day 7,14 and 21 after PVE or LVD.FLR-V and FLR-F variations were compared using multivariate generalized linear mixed models(joint modelling)with/without missing data imputation.Results:Baseline FLR-F was lower in the LVD(n=29)than PVE group(n=22)(P<0.001).Technical success was 100%in both groups without any major complication.Changes in FLR-V at day 14 and 21(+14.2%vs.+50%,P=0.002;and+18.6%vs.+52.6%,P=0.001),and in FLR-F at day 7,14 and 21(+23.1%vs.+54.3%,P=0.02;+17.6%vs.+56.1%,P=0.006;and+29.8%vs.+63.9%,P<0.001)differed between PVE and LVD group.LVD(P=0.009),age(P=0.027)and baseline FLR-V(P=0.001)independently predicted FLR-V variations,whereas only LVD(P=0.01)predicted FLR-F changes.After missing data handling,LVD remained an independent predictor of FLR-V and FLR-F variations.Conclusions:LVD is safe and provides greater FLR-V and FLR-F increase than PVE.These results are now evaluated in the HYPERLIV-01 multicenter randomized trial.展开更多
文摘Background:While preliminary reports on resection following downstaging using transarterial radioembolization(TARE)for intermediate or advanced hepatocellular carcinomas(HCCs)reported promising oncological outcomes,there’s a notable gap in the literature concerning post operative morbidity.Contrary to post hepatectomy liver failure(PHLF),damages to the bile ducts and their potential consequences have been poorly evaluated.Thus,our aim was to explore postoperative complications in HCC patients undergoing liver resection after Y90 TARE,focusing particularly on biliary complications.Methods:Conducted from June 2015 to December 2022,this retrospective study involved 30 HCC patients undergoing liver resection post-TARE.Comprehensive data on surgical procedures,complications,and follow-up were collected.Logistic regression analyses were conducted,starting with univariate analysis followed by multivariate analysis,focusing on variables with a significance level below P<0.2.Results:The objective response rate(ORR)in the TARE-treated area was 97%at 3 months.Survival outcomes showed a median overall survival(OS)of 5.1 years and progression-free survival(PFS)of 3.5 years post-liver resection.The study found a 40%(12 out of 30 patients)rate of severe postoperative complications and a 7%(2 out of 30 patients)90-day mortality rate.After liver resection,grade B bile leaks occurred in 20%(6 out of 30)of patients,with a third experiencing recurrence.Biliary-specific mortality was 9%.After multivariate analysis,only the interval between TARE and surgery emerged a significant risk factor for biliary complications,showing increased odds of bile leaks if surgery occurred 3-6 months post-TARE compared to after 6 months.Conclusions:This study highlights the importance of timing between TARE and surgery,suggesting a waiting period of at least 6 months.Such timing not only enhances the radiation effects of TARE but also optimizes both future liver remnant growth and patient selection.
文摘Background:We previously showed that embolization of portal inflow and hepatic vein(HV)outflow(liver venous deprivation,LVD)promotes future liver remnant(FLR)volume(FLR-V)and function(FLR-F)gain.Here,we compared FLR-V and FLR-F changes after portal vein embolization(PVE)and LVD.Methods:This study included all patients referred for liver preparation before major hepatectomy over 26 months.Exclusion criteria were:unavailable baseline/follow-up imaging,cirrhosis,Klatskin tumor,two-stage hepatectomy.99mTc-mebrofenin SPECT-CT was performed at baseline and at day 7,14 and 21 after PVE or LVD.FLR-V and FLR-F variations were compared using multivariate generalized linear mixed models(joint modelling)with/without missing data imputation.Results:Baseline FLR-F was lower in the LVD(n=29)than PVE group(n=22)(P<0.001).Technical success was 100%in both groups without any major complication.Changes in FLR-V at day 14 and 21(+14.2%vs.+50%,P=0.002;and+18.6%vs.+52.6%,P=0.001),and in FLR-F at day 7,14 and 21(+23.1%vs.+54.3%,P=0.02;+17.6%vs.+56.1%,P=0.006;and+29.8%vs.+63.9%,P<0.001)differed between PVE and LVD group.LVD(P=0.009),age(P=0.027)and baseline FLR-V(P=0.001)independently predicted FLR-V variations,whereas only LVD(P=0.01)predicted FLR-F changes.After missing data handling,LVD remained an independent predictor of FLR-V and FLR-F variations.Conclusions:LVD is safe and provides greater FLR-V and FLR-F increase than PVE.These results are now evaluated in the HYPERLIV-01 multicenter randomized trial.
