Laparoscopic placement of hepatic artery infusion pumps: technical considerations and early results.

Abstract

BACKGROUND:

Laparoscopic hepatic artery infusion pump (LHAIP) placement is a novel treatment option for patients with colorectal liver metastases. This study investigates technical difficulties with regard to variant hepatic arteries and the preliminary outcomes for patients treated with LHAIP placement.

METHODS:

Between March 1998 and January 2003, 38 patients with colorectal metastases confined to the liver, 35 (92%) of who had prior systemic chemotherapy that failed, were treated with LHAIP.

RESULTS:

Twelve patients (32%) had LHAIP placement only, and 26 (68%) had pump placement combined with laparoscopic radiofrequency ablation (LRFA; 24 patients) and/or liver resection (2 patients). Variant hepatic arterial (HA) anatomy was present in 18 patients (47%). The presence of a variant HA did not increase pump complications, operative time, or blood loss (P >/=.20) or decrease the functional time of pump use (P =.91) in comparison with normal anatomy. In all patients with a variant HA, laparoscopic ligation of the variant vessel and/or cannulation of nongastroduodenal artery resulted in complete hepatic perfusion. Three misperfusions identified intraoperatively with use of methylene blue injection were corrected by laparoscopic ligation (two) or postoperative angioembolization (one). Postoperative pump radionuclide flow studies confirmed isolated hepatic artery infusion in all cases. There was a 13% pump-related complication rate. During a median follow-up of 11 months (0.5 to 35.5 months), the actuarial rate of overall survival was 47% and the estimated median survival time was 17.5 months.

CONCLUSIONS:

LHAIP placement is technically feasible, and variant HA is not associated with increased pump complications or decreased pump functional time.

• Authors: Jun Cheng, Dennis Hong, Guojing Zhu, Lee L Swanstrom, Paul D Hansen
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 11 Issue 6 Pg. 589-97 (Jun 2004) ISSN: 1068-9265 [Print] United States
• PMID: 15150068 (Publication Type: Clinical Trial, Journal Article)

Topics

• Aged
• Aged, 80 and over
• Colorectal Neoplasms (pathology)
• Female
• Hepatic Artery (surgery)
• Humans
• Infusion Pumps, Implantable
• Infusions, Intra-Arterial (instrumentation)
• Laparoscopy (methods)
• Liver Neoplasms (drug therapy, mortality, secondary)
• Male
• Middle Aged
• Perioperative Care
• Postoperative Complications (epidemiology)
• Quality of Life
• Survival Rate
• United States (epidemiology)