Al Taweel Bader, Cassese Gianluca, Meerun Azhar, Rivière Benjamin, Navarro Francis, Guiu Boris, Panaro Fabrizio
Division of Digestive Surgery and Transplantation, Department of Surgery, St. Eloi Hospital, Montpellier University Hospital-School of Medicine, Montpellier, France.
Division of Minimally Invasive and Robotic HPB Surgery and Transplantation Service, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy.
Hepatobiliary Surg Nutr. 2025 Aug 1;14(4):552-561. doi: 10.21037/hbsn-23-429. Epub 2025 Jul 25.
Selective internal radiation therapy (SIRT) has emerged as a promising and recent treatment for downstaging hepatocellular carcinoma (HCC) before surgical intervention. However, the potential occurrence of postoperative biliary and respiratory complications following major hepatectomy subsequent to SIRT remains unclear. We hypothesized that SIRT can increase the rate of biliary leakage and cause diaphragmatic dysfunction, especially for huge HCC in contact with the diaphragm.
We conducted a retrospective study including consecutive HCC patients from January 2015 to December 2022 undergoing right hepatectomy after SIRT in the Montpellier University Hospital. Patients were compared in a 1:1 ratio with non-SIRT-treated patients based on the following criteria: same diagnosis, same surgery, same American Society of Anesthesiologists (ASA) score, Child-Turcotte-Pugh (CTP) class, and similar tumor burden. Analysis was done using either a linear or logistic regression. Outcomes were the rate of biliary leakage and of 3 diaphragm-related complications: oxygen flow on day 1, need for intensive oxygen therapy, and pleural effusion.
Twenty patients with comparable preoperative characteristics were included in each group. Eight patients (40%) in the SIRT group experienced a postoperative bile leak versus only 2 (10%) in the other, with a significantly increased risk [odds ratio (OR) =6; 95% confidence interval (CI): 1.1-33.3; P<0.05]. Similarly, the risk of large postoperative pleural effusion was increased after SIRT, with 6 patients (30%) against 0, respectively (OR =10.5; 95% CI: 1.8-61.4; P<0.05).
SIRT may increase the risk of postoperative biliary leakage and respiratory complications after right hepatectomy.
选择性内放射治疗（SIRT）已成为一种有前景的新型治疗方法，用于在手术干预前降低肝细胞癌（HCC）的分期。然而，SIRT后进行肝大部切除术后发生胆系和呼吸并发症的可能性仍不明确。我们推测SIRT会增加胆漏发生率并导致膈肌功能障碍，尤其是对于与膈肌相邻的巨大HCC。
我们进行了一项回顾性研究，纳入了2015年1月至2022年12月在蒙彼利埃大学医院接受SIRT后行右半肝切除术的连续性HCC患者。根据以下标准将患者与未接受SIRT治疗的患者按1:1比例进行比较：相同诊断、相同手术、相同美国麻醉医师协会（ASA）评分、Child-Turcotte-Pugh（CTP）分级以及相似的肿瘤负荷。采用线性或逻辑回归进行分析。观察指标为胆漏发生率以及3种与膈肌相关的并发症：术后第1天的氧流量、是否需要强化氧疗以及胸腔积液。
每组纳入20例术前特征相当的患者。SIRT组有8例患者（40%）发生术后胆漏，而另一组仅2例（10%），风险显著增加[比值比（OR）=6；95%置信区间（CI）：1.1 - 33.3；P<0.05]。同样，SIRT后术后大量胸腔积液的风险也增加，分别为6例患者（30%）和0例（OR = 10.5；95% CI：1.8 - 61.4；P<0.05）。
SIRT可能会增加右半肝切除术后胆漏和呼吸并发症的风险。
