Kalra Aryan, Rowcroft Alistair, Trinder Matthew, Ballal Mohammed, Bhandari Mayank
School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.
Department of General Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia.
J Gastrointest Surg. 2024 Dec;28(12):1970-1975. doi: 10.1016/j.gassur.2024.09.007. Epub 2024 Sep 10.
Selective internal radiation therapy (SIRT) with yttrium-90 (Y-90) has been historically reserved for unresectable liver malignancy. Evidence is emerging for the use of SIRT to increase future liver remnant (FLR), allowing for the resection of previously inoperable disease.
This was a 5-year retrospective review of all patients undergoing SIRT with Y-90 at a tertiary institute. Patient demographics, clinicopathologic data, surgical details, and postoperative outcomes were reviewed. The primary outcome, safety of liver resection after SIRT, was evaluated with 90-day morbidity and mortality.
A total of 134 SIRT procedures were performed on 113 patients. Post-SIRT complications occurred in 18 patients (15.9%), with a single 30-day mortality. In addition, 17 patients underwent SIRT with the intent to augment FLR for liver resection. After SIRT, mean hepatic mebrofenin extraction and FLR increased from 2.5%/min/m and 30.5% to 4.2%/min/m and 52.5% (P = .01 and P < .0001, respectively). Ten patients underwent resection, and there were 2 intraoperative complications. The median time from SIRT to resection was 5.2 months. The 90-day postoperative morbidity was 20% (n = 2), and complications were analyzed according to the Clavien-Dindo II classification scale. There was no 30-day or 90-day postoperative mortality.
Post-SIRT liver resection is a challenging procedure with low postoperative mortality and morbidity.
钇-90（Y-90）选择性内放射治疗（SIRT）在历史上一直用于不可切除的肝脏恶性肿瘤。越来越多的证据表明，使用SIRT可增加未来肝脏残余量（FLR），从而能够切除先前无法手术的疾病。
这是一项对某三级医疗机构中所有接受Y-90 SIRT治疗的患者进行的为期5年的回顾性研究。回顾了患者的人口统计学、临床病理数据、手术细节和术后结果。以90天的发病率和死亡率评估主要结局，即SIRT后肝切除的安全性。
共对113例患者进行了134次SIRT手术。18例患者（15.9%）出现SIRT后并发症，30天内有1例死亡。此外，17例患者接受SIRT的目的是增加FLR以进行肝切除。SIRT后，平均肝美布芬宁摄取率和FLR分别从2.5%/分钟/米和30.5%增加到4.2%/分钟/米和52.5%（P分别为0.01和<0.0001）。10例患者接受了手术，术中出现2例并发症。从SIRT到手术的中位时间为5.2个月。术后90天发病率为20%（n = 2），并根据Clavien-Dindo II分类量表分析并发症。术后30天和90天均无死亡。
SIRT后肝切除是一项具有挑战性的手术，术后死亡率和发病率较低。
