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Hepatectomy After Yttrium-90 (Y90) Radioembolization-Induced Liver Fibrosis
Ajay V Maker1,2,3, Carey August4, Vijay K Maker5,6
1Division of Surgical Oncology, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA. amaker@uic.edu.
Summary
This study reports on a patient with metastatic neuroendocrine carcinoma treated with yttrium-90 (Y90) radioembolization followed by hepatectomy. The procedure, while complex due to Y90-induced fibrosis, successfully removed tumors and relieved symptoms.
Area of Science:
- Hepatobiliary surgery
- Interventional radiology
- Neuroendocrine tumor management
Background:
- A 55-year-old woman with ileal carcinoid tumor metastasis and carcinoid syndrome underwent yttrium-90 (Y90) radioembolization.
- Despite treatment, she remained symptomatic with multifocal liver metastases.
Observation:
- Imaging revealed stable liver lesions after Y90 treatment, with significant hypertrophy of the non-treated liver segments.
- Exploration showed fibrotic, damaged liver tissue in the treated areas, consistent with Y90-induced changes.
Findings:
- An extended right hepatectomy was performed, removing 15 foci of metastatic neuroendocrine carcinoma.
- Histopathology confirmed Y90 radioembolization microbeads within vessels and surrounding tumors.
Implications:
- Hepatectomy following Y90 radioembolization is feasible but associated with increased morbidity due to liver fibrosis.
- Complete metastasectomy remains crucial for symptom improvement, quality of life, and survival in neuroendocrine liver metastases.
