Hepatic artery infusion pumps: A surgical toolkit for intraoperative decision-making and management of hepatic artery infusion-specific complications Journal Article
| Authors: | Sharib, J. M.; Creasy, J. M.; Wildman-Tobriner, B.; Kim, C.; Uronis, H.; Hsu, S. D.; Strickle, J. H.; Gholami, S.; Cavnar, M.; Merkow, R. P.; Kingham, P.; Kemeny, N.; Zani, S. Jr; Jarnagin, W. R.; Allen, P. J.; D'Angelica, M. I.; Lidsky, M. E. |
| Article Title: | Hepatic artery infusion pumps: A surgical toolkit for intraoperative decision-making and management of hepatic artery infusion-specific complications |
| Abstract: | Background: Hepatic artery infusion (HAI) is a liver-directed therapy that delivers high-dose chemotherapy to the liver through the hepatic arterial system for colorectal liver metastases and intrahepatic cholangiocarcinoma. Utilization of HAI is rapidly expanding worldwide. Objective and Methods: This review describes the conduct of HAI pump implantation, with focus on common technical pitfalls and their associated solutions. Perioperative identification and management of common postoperative complications is also described. Results: HAI therapy is most commonly performed with the surgical implantation of a subcutaneous pump, and placement of its catheter into the hepatic arterial system for inline flow of pump chemotherapy directly to the liver. Intraoperative challenges and abnormal hepatic perfusion can arise due to aberrant anatomy, vascular disease, technical or patient factors. However, solutions to prevent or overcome technical pitfalls are present for the majority of cases. Postoperative HAI-specific complications arise in 22% to 28% of patients in the form of pump pocket (8%-18%), catheter (10%-26%), vascular (5%-10%), or biliary (2%-8%) complications. The majority of patients can be rescued from these complications with early identification and aggressive intervention to continue to deliver safe and effective HAI therapy. Conclusions: This HAI toolkit provides the HAI team a reference to manage commonly encountered HAI-specific perioperative obstacles and complications. Overcoming these challenges is critical to ensure safe and effective pump implantation and delivery of HAI therapy, and key to successful implementation of new programs and expansion of HAI to patients who may benefit from such a highly specialized treatment strategy. © 2022 Lippincott Williams and Wilkins. All rights reserved. |
| Keywords: | liver neoplasms; antineoplastic agent; antineoplastic combined chemotherapy protocols; pathology; colorectal neoplasms; colorectal tumor; liver tumor; intraarterial drug administration; infusions, intra-arterial; hepatic artery; colorectal liver metastases; infusion pumps, implantable; adverse event; humans; human; hepatic artery infusion pump; adverse device effect; implantable infusion pump |
| Journal Title: | Annals of Surgery |
| Volume: | 276 |
| Issue: | 6 |
| ISSN: | 0003-4932 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2022-12-01 |
| Start Page: | 943 |
| End Page: | 956 |
| Language: | English |
| DOI: | 10.1097/sla.0000000000005434 |
| PUBMED: | 36346892 |
| PROVIDER: | scopus |
| PMCID: | PMC9700364 |
| DOI/URL: | |
| Notes: | Review -- Export Date: 1 December 2022 -- Source: Scopus |
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781D'Angelica -
616Kingham -
544Kemeny
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