Imperial College London
Alternate

Dr David Laith Rawaf

Faculty of Medicine, School of Public Health

Web Editor for the WHO Collaborating Centre
 
 
 
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Contact

 

d.rawaf Website

 
 
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Location

 

Reynolds BuildingCharing Cross Campus

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Summary

 

Publications

Citation

BibTex format

@article{Mangieri:2023:10.1016/j.amjsurg.2022.10.017,
author = {Mangieri, CW and Valenzuela, CD and Strode, MA and Erali, RA and Shen, P and Howerton, R and Clark, CJ},
doi = {10.1016/j.amjsurg.2022.10.017},
journal = {Am J Surg},
pages = {703--708},
title = {Effect of preoperative liver-directed therapy prior to hepatic resection.},
url = {http://dx.doi.org/10.1016/j.amjsurg.2022.10.017},
volume = {225},
year = {2023}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - INTRODUCTION: Hepatobiliary malignancies present with advanced disease precluding upfront resection. Liver-directed therapy (LDT), particularly Y-90 radioembolization and transarterial chemoembolization (TACE), has become increasingly utilized to facilitate attempt at oncologic resection. However, the safety profile of preoperative LDT is limited. METHODS: Retrospective review of the ACS NSQIP main and targeted hepatectomy registries for 2014-2016. Primary objective was evaluation of outcomes between preoperative LDT cases and those that received upfront resection. RESULTS: A total of 8923 cases met selection criteria. 192 cases (2.15%) received either Y-90 or TACE prior to hepatectomy. Multivariate analysis for all study patients revealed preoperative LDT significantly increased the risk of perioperative transfusion (OR 2.19, 95% CI 1.445-3.328, P < 0.0001), sepsis (OR 2.21, 95% CI 1.104-4.411, P = 0.022), and liver failure (OR 2.72, 95% CI 1.562-4.747, P < 0.0001). Subgroup analysis found for primary hepatobiliary malignancies LDT only increased the risk for liver failure. While for secondary hepatic tumors LDT significantly increased perioperative transfusion, sepsis, cardiac failure, renal failure, liver failure, and mortality. The complication profile also significantly increased with advanced T stage. Conversely, on propensity score matching preoperative LDT did not significantly increase perioperative complications. CONCLUSION: Preoperative LDT has the potential to convert inoperable hepatic tumors into resectable disease but there is a general increased risk for significant postoperative complications, most notable liver failure. However, on controlled analysis preoperative LDT does not increase perioperative complications and should not be considered a contraindication to resection.
AU  - Mangieri,CW
AU  - Valenzuela,CD
AU  - Strode,MA
AU  - Erali,RA
AU  - Shen,P
AU  - Howerton,R
AU  - Clark,CJ
DO  - 10.1016/j.amjsurg.2022.10.017
EP  - 708
PY  - 2023///
SP  - 703
TI  - Effect of preoperative liver-directed therapy prior to hepatic resection.
T2  - Am J Surg
UR  - http://dx.doi.org/10.1016/j.amjsurg.2022.10.017
UR  - https://www.ncbi.nlm.nih.gov/pubmed/36307334
VL  - 225
ER  -
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