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. 2025 Jun 1;14(3):398-410.
doi: 10.21037/hbsn-24-151. Epub 2024 Nov 19.

Evaluating liver resection outcomes post Y90 TARE with personalized dosimetry in intermediate or advanced hepatocellular carcinoma: a focus on surgical and biliary complications

Mohamad Azhar Meerun  1 , Carole Allimant  1 , Valentina Schembri  1 , Margaux Hermida  1 , Christine Latry-Kuhn  2 , Denis Mariano-Goulart  2 , Fabrizio Panaro  3 , Boris Guiu  1
Affiliations

Evaluating liver resection outcomes post Y90 TARE with personalized dosimetry in intermediate or advanced hepatocellular carcinoma: a focus on surgical and biliary complications

Mohamad Azhar Meerun et al. Hepatobiliary Surg Nutr. .

Abstract

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.

Keywords: Transarterial radioembolization (TARE); bile leaks; hepatocellular carcinoma (HCC); liver resection.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-24-151/coif). F.P. and B.G. serve as the unpaid editorial board members of HepatoBiliary Surgery and Nutrition. C.A. reports consulting fees from Boston Scientific. B.G. received research grants from Roche and Guerbet and consulting fees from Roche, BMS, AstraZeneca, Canon Medical System and Boston Scientific. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Study flow chart. TARE, transarterial radioembolization; HCC, hepatocellular carcinoma.
Figure 2
Figure 2
Survival outcomes for HCC patients undergoing surgery after TARE. Overall (A) and progression-free (B) survivals. CI, confidence interval; NR, not reached; HCC, hepatocellular carcinoma; TARE, transarterial radioembolization.
See this image and copyright information in PMC

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