Hepatectomy after hepatic arterial therapy with either yttrium-90 or drug-eluting bead chemotherapy: is it safe?

Background: The use of hepatic arterial therapy (HAT) with either yttrium-90 or drug-eluting bead therapy for initially unresectable hepatic malignancies has risen significantly. The safety of hepatic resection after hepatic arterial therapy (HAT) is not established. Objective: The present study evaluates the safety profile for hepatic resection after HAT. Methods: We identified 840 patients undergoing hepatectomy for primary or metastatic lesions. Forty patients underwent HAT before hepatectomy (pre-HAT). A 1 : 4 case-matched analysis compared three groups: (i) pre-HAT and pre-operative chemotherapy (n = 40); (ii) pre-operative chemotherapy (n = 160); and (iii) no pre-operative therapy (n = 640). Controls were matched for age, resection type, maximal tumour size and magnitude of resection. Morbidity and mortality among groups were compared using a graded complication scale. Results: There were no differences in post-operative complications, grade of complication or liver-specific complications among the groups. A proportional hazards model for all patients did not demonstrate any association between increased complications and either pre-HAT or pre-operative chemotherapy when compared with patients without pre-operative therapy (P = 0.7). Conclusions: Pre-HAT demonstrated similar morbidity, liver-specific morbidity and intra-operative complications when compared with patients undergoing pre-operative chemotherapy alone or without preoperative chemotherapy. These results suggest that pre-HAT is safe and should not preclude hepatectomy in carefully selected patients.