# Impact of Preoperative Yttrium-90 Transarterial Radioembolization on Patients Undergoing Right or Extended Right Hepatectomy for Hepatocellular Carcinoma

## TL;DR

Using Yttrium-90 radioembolization before liver surgery for advanced liver cancer improves survival and reduces recurrence without increasing surgical risk.

## Contribution

Demonstrates that preoperative Yttrium-90 transarterial radioembolization improves oncological outcomes in borderline resectable hepatocellular carcinoma.

## Key findings

- Patients receiving preoperative TARE had significantly higher cancer-specific and recurrence-free survival rates.
- TARE led to greater tumor necrosis and enabled more extended resections without increasing surgical risk.
- Five-year cancer-specific survival was 80.4% in the TARE group versus 33.5% in the upfront surgery group.

## Abstract

Hepatocellular carcinoma (HCC) is often diagnosed at an advanced stage, limiting curative-intent treatment options. For patients with large tumors or those showing macrovascular invasion, major hepatectomy may be required, but carries substantial risk. This study investigated the impact of Yttrium-90 transarterial radioembolization (TARE) before surgery in patients undergoing right or extended right hepatectomy for HCC. Among 39 patients, 18 received preoperative TARE and 21 underwent upfront resection. While perioperative outcomes were similar, the TARE group demonstrated significantly better long-term oncological results, including higher cancer-specific survival, recurrence-free survival, and curative-intent disease-free survival. TARE also led to greater tumor necrosis and enabled more extended resections without increasing surgical risk. These findings suggest that TARE may be a safe and effective neoadjuvant option in selected patients with borderline resectable HCC, including those with macrovascular invasion, potentially improving outcomes and aiding surgical decision-making.

Background/Objectives: Preoperative strategies for hepatocellular carcinoma (HCC) requiring major hepatectomy remain controversial, particularly in “borderline resectable” cases. This study aimed to evaluate the oncological benefit and perioperative safety of Yttrium-90 transarterial radioembolization (TARE) in patients undergoing right or extended right hepatectomy for HCC. Material and Methods: All consecutive patients who underwent right or extended right hepatectomy for HCC at a single tertiary center between January 2013 and December 2023 were retrospectively reviewed. Patients were grouped based on whether they received preoperative TARE or underwent upfront resection. Outcomes analyzed included perioperative morbidity and long-term oncological endpoints. Results: A total of 39 patients were included, of whom 18 received preoperative TARE and 21 underwent upfront surgery. Patients in the TARE group showed significantly greater tumor necrosis at pathology (70% vs. 10%, p = 0.002) and more frequent extended resections. Five-year cancer-specific survival (80.4% vs. 33.5%, p = 0.011), recurrence-free survival (33.8% vs. 14.0%, p = 0.047), and curative-intent disease-free survival (69.3% vs. 18.9%, p = 0.0037) were significantly higher in the TARE group. Overall survival showed a favorable trend. Intraoperative outcomes, postoperative morbidity, and 90-day mortality were comparable between groups. Conclusions: Preoperative TARE is a safe and effective neoadjuvant strategy in selected patients with HCC undergoing major hepatectomy. It may enhance long-term oncological outcomes without increasing surgical risk, supporting its potential role in the management of borderline resectable HCC.