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Bonde A, Fung AW, Mayo SC, Li P, Walker BS, Jaganathan S, Mallak N, Korngold EK. Imaging of the hepatic arterial infusion pump: Primer for radiologists. Clin Imaging 2024; 105:110022. [PMID: 37992624 DOI: 10.1016/j.clinimag.2023.110022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/22/2023] [Accepted: 10/31/2023] [Indexed: 11/24/2023]
Abstract
Hepatic arterial infusion (HAI) pumps are used to deliver liver-directed therapy by allowing the administration of selective chemotherapy to the liver via a catheter implanted most commonly into the gastroduodenal artery connected to a subcutaneous pump. This selective administration helps maximize the chemotherapeutic effect within the hepatic tumors while minimizing systemic toxicity. While HAI therapy has primarily been used to treat liver-only metastatic colorectal cancer, the indications have expanded to other malignancies, including intrahepatic cholangiocarcinoma. Radiologists play an important role in pre-operative planning, assessment of treatment response, and evaluation for potential complications using various imaging studies, including computed tomography angiography, magnetic resonance imaging, and perfusion scintigraphy. This article describes the radiologist's role as part of a multi-disciplinary oncology team to help maximize the success of HAI therapy and also helps radiologists familiarize themselves with various aspects of HAI pumps.
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Affiliation(s)
- Apurva Bonde
- Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States of America.
| | - Alice W Fung
- Department of Radiology, Oregon Health & Science University, Knight Cancer Institute, 3181 Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America
| | - Skye C Mayo
- Department of Surgical Oncology, Oregon Health & Science University, Knight Cancer Institute, 3181 Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America
| | - Peter Li
- Department of Radiology, Oregon Health & Science University, Knight Cancer Institute, 3181 Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America
| | - Brett S Walker
- Department of Surgical Oncology, Oregon Health & Science University, Knight Cancer Institute, 3181 Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America
| | - Sriram Jaganathan
- Department of Radiology, University of Arkansas for Medical Sciences, 4301 W Markham St, AR 72205, United States of America
| | - Nadine Mallak
- Department of Radiology, Oregon Health & Science University, Knight Cancer Institute, 3181 Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America
| | - Elena K Korngold
- Department of Radiology, Oregon Health & Science University, Knight Cancer Institute, 3181 Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America
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Sharib JM, Creasy JM, Wildman-Tobrine B, Kim C, Uronis H, Hsu SD, Strickle JH, Gholami S, Cavna M, Merkow RP, Kingham P, Kemeny N, Zani S, Jarnagin WR, Allen PJ, D’Angelica MI, Lidsky ME. Hepatic Artery Infusion Pumps: A Surgical Toolkit for Intraoperative Decision-Making and Management of Hepatic Artery Infusion-Specific Complications. Ann Surg 2022; 276:943-956. [PMID: 36346892 PMCID: PMC9700364 DOI: 10.1097/sla.0000000000005434] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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.
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Affiliation(s)
- Jeremy M. Sharib
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - John M. Creasy
- Department of Surgery, Duke University Medical Center, Durham, NC
| | | | - Charles Kim
- Department of Radiology, Duke University Medical Center, Durham, NC
| | - Hope Uronis
- Department of Medicine, Duke University Medical Center, Durham, NC
| | | | - John H. Strickle
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Sepideh Gholami
- Department of Surgery, University of California-Davis, Sacramento, CA
| | - Michael Cavna
- Department of Surgery, University of Ken-tucky, Lexington, KY
| | - Ryan P. Merkow
- Surgical Outcomes and Quality improvement Center, Department of Surgery, Feinberg School of Medicine, North-western University, Chicago, IL
| | - Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nancy Kemeny
- Department of Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sabino Zani
- Department of Surgery, Duke University Medical Center, Durham, NC
| | | | - Peter J. Allen
- Department of Surgery, Duke University Medical Center, Durham, NC
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Napier KJ, Lidsky ME, James OG, Wildman-Tobriner B. Hepatic Arterial Infusion Pumps: What the Radiologist Needs to Know. Radiographics 2021; 41:895-908. [PMID: 33769890 DOI: 10.1148/rg.2021200130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hepatic arterial infusion (HAI) entails the surgical implantation of a subcutaneous pump to deliver chemotherapeutic agents directly to the liver in the setting of primary or secondary liver cancer. The purpose of HAI chemotherapy is to maximize hepatic drug concentrations while minimizing systemic toxicity, facilitating more effective treatment. HAI is used in combination with systemic chemotherapy and can be considered in several clinical scenarios, including adjuvant therapy, conversion of unresectable disease to resectable disease, and unresectable disease. Radiologists are key members of the multidisciplinary team involved in the selection and management of these patients with complex liver disease. As these devices begin to be used at more sites across the country, radiologists should become familiar with the guiding principles behind pump placement, expected imaging appearances of these devices, and potential associated complications. The authors provide an overview of HAI therapy, with a focus on the key imaging findings associated with this treatment that radiologists may encounter. ©RSNA, 2021.
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Affiliation(s)
- Kyle J Napier
- From the Departments of Radiology (K.J.N., O.G.J., B.W.T.) and Surgery (M.E.L.), Duke University Medical Center, Box 3808, Durham, NC 27710
| | - Michael E Lidsky
- From the Departments of Radiology (K.J.N., O.G.J., B.W.T.) and Surgery (M.E.L.), Duke University Medical Center, Box 3808, Durham, NC 27710
| | - Olga G James
- From the Departments of Radiology (K.J.N., O.G.J., B.W.T.) and Surgery (M.E.L.), Duke University Medical Center, Box 3808, Durham, NC 27710
| | - Benjamin Wildman-Tobriner
- From the Departments of Radiology (K.J.N., O.G.J., B.W.T.) and Surgery (M.E.L.), Duke University Medical Center, Box 3808, Durham, NC 27710
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Walker BS, Sutton TL, Eil RL, Korngold EK, Kolbeck KJ, Billingsley KG, Mayo SC. Conventional hepatic arterial anatomy? Novel findings and insights of a multi-disciplinary hepatic arterial infusion pump program. Am J Surg 2021; 221:1188-1194. [PMID: 33685717 DOI: 10.1016/j.amjsurg.2021.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/14/2021] [Accepted: 02/22/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Variant hepatic arterial anatomy (vHAA) is thought to occur in 20-30% of patients. Hepatic arterial infusion (HAI) pump placement for liver cancers requires thorough hepatic artery dissection; we sought to compare vHAA identified during pump placement with established dogma. METHODS Between 2016 and 2020, n = 30 patients received a HAI pump. Intra-operatively identified vHAA was characterized and compared with published data. RESULTS vHAA was identified in 60% (n = 18) of patients, significantly higher than 19% (3671 of 19013) in the largest published series (P < 0.001). The most common variations were accessory left (n = 12; 40%) and replaced right (n = 6; 20%) hepatic arteries; six (20%) had ≥2 variants. Pre-operative imaging correctly identified 67% of variant hepatic arteries. DISCUSSION Meticulous operative dissection of the hepatic arterial tree reveals vHAA not captured by imaging or cadaveric dissection. vHAA likely has a higher prevalence than previously reported and should be addressed to optimize therapeutic efficacy of HAI pump therapy.
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Affiliation(s)
- Brett S Walker
- Oregon Heath & Science University (OHSU), Department of Surgery, Division of Surgical Oncology, Portland, OR, 97239, USA
| | - Thomas L Sutton
- Oregon Heath & Science University (OHSU), Department of Surgery, Division of Surgical Oncology, Portland, OR, 97239, USA
| | - Robert L Eil
- Oregon Heath & Science University (OHSU), Department of Surgery, Division of Surgical Oncology, Portland, OR, 97239, USA; The Knight Cancer Institute at OHSU, Portland, OR, 97239, USA
| | - Elena K Korngold
- OHSU, Department of Diagnostic Radiology, Section of Body Imaging, Portland, OR, 97239, USA
| | - Kenneth J Kolbeck
- OHSU, Charles T. Dotter Department of Interventional Radiology, Portland, OR, 97239, USA
| | - Kevin G Billingsley
- Oregon Heath & Science University (OHSU), Department of Surgery, Division of Surgical Oncology, Portland, OR, 97239, USA; The Knight Cancer Institute at OHSU, Portland, OR, 97239, USA
| | - Skye C Mayo
- Oregon Heath & Science University (OHSU), Department of Surgery, Division of Surgical Oncology, Portland, OR, 97239, USA; The Knight Cancer Institute at OHSU, Portland, OR, 97239, USA.
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Hasan O, Greco S, Kennedy T, Carpizo D, Kempf J, Nosher J. Aberrant arc between the common hepatic artery and a replaced right hepatic artery resulting in misperfusion in a patient with a hepatic arterial infusion pump. Surg Radiol Anat 2019; 41:355-358. [PMID: 30612141 DOI: 10.1007/s00276-018-2158-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
Abstract
Hepatic arterial infusion pumps are increasingly utilized as an option for liver directed therapy in the treatment of metastatic colorectal carcinoma. After skeletonization of the hepatic artery through the ligation of extra-hepatic branches, these pumps are implanted surgically with their tip placed in the common hepatic artery. Subsequently, a nuclear medicine pump study is performed to ensure homogeneous perfusion of the liver and detect any extrahepatic perfusion. We report a peripheral arc between the superior mesenteric artery and celiac axis, which caused misperfusion on the SPECT nuclear medicine scan.
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Affiliation(s)
- Omar Hasan
- Department of Radiology, Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, MEB #404, New Brunswick, NJ, 08901, USA
| | - Stephanie Greco
- Department of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Timothy Kennedy
- Department of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Darren Carpizo
- Department of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Jeffrey Kempf
- Department of Radiology, Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, MEB #404, New Brunswick, NJ, 08901, USA
| | - John Nosher
- Department of Radiology, Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, MEB #404, New Brunswick, NJ, 08901, USA.
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Doussot A, Kemeny NE, D'Angelica MI. Hepatic arterial infusional chemotherapy in the management of colorectal cancer liver metastases. Hepat Oncol 2015; 2:275-290. [PMID: 30191008 DOI: 10.2217/hep.15.9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Colorectal liver metastases (CRLM) receive their blood supply predominantly through the hepatic artery. Intra-arterial drug delivery can optimize the dose and time exposure of chemotherapy to tumor cells while limiting systemic toxicity. Chemotherapy is most commonly administered through a catheter surgically placed in the gastroduodenal artery and connected to a subcutaneous pump. Due to its pharmacokinetics features, floxuridine is the most commonly used drug in the USA with hepatic arterial infusional (HAI) chemotherapy. To date, many clinical trials have shown the positive impact of HAI in the management of CRLM. Hence, in unresectable patients, HAI is associated with high response rates and commonly enables subsequent resection in both chemonaive and previously treated patients. Outcomes in patients converted to complete resection are similar to patients who present with initially resectable disease. In the adjuvant setting, HAI with floxuridine improves survival as well as hepatic and overall disease-free survival after complete resection of CRLM, as compared with 5-FU alone, in three of four randomized studies. To date, no trials have compared HAI combined with modern chemotherapy alone to modern chemotherapy alone in the adjuvant setting.
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Affiliation(s)
- Alexandre Doussot
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.,Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
| | - Nancy E Kemeny
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.,Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Michael I D'Angelica
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.,Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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Abstract
To date, hepatic artery infusion (HAI) chemotherapy has primarily been investigated in the setting of colorectal cancer liver metastases (CRLM). Few studies have been conducted in North America regarding HAI chemotherapy for primary liver cancers (PLC) or noncolorectal liver metastases (non-CRLM). Despite decades of evaluation, controversy surrounding the use of HAI chemotherapy still exists. In this article the methods of HAI chemotherapy delivery, technical aspects of catheter and pump insertion, and specific complications of HAI chemotherapy are discussed. Outcomes of clinical trials and reviews of HAI chemotherapy in the setting of CRLM, PLC, and non-CRLM are evaluated.
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Affiliation(s)
- Julie N Leal
- Department of Surgery, Division of Hepatopancreatobiliary Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - T Peter Kingham
- Department of Surgery, Division of Hepatopancreatobiliary Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Perez DR, Kemeny NE, Brown KT, Gewirtz AN, Paty PB, Jarnagin WR, D'Angelica MI. Angiographic identification of extrahepatic perfusion after hepatic arterial pump placement: implications for surgical prevention. HPB (Oxford) 2014; 16:744-8. [PMID: 24345007 PMCID: PMC4113257 DOI: 10.1111/hpb.12208] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 11/06/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatic arterial infusion (HAI) chemotherapy is an effective treatment for patients with liver malignancy. Extrahepatic perfusion (EHP) after HAI pump placement requires correction prior to starting chemotherapy. The aim of this study was to define the origin of arterial branches causing EHP in order to determine if alterations in surgical technique during pump placement might prevent EHP. METHODS A prospectively maintained, single-centre HAI database was reviewed for all patients (2008-2011) with EHP. The origin of arterial branches causing EHP was classified anatomically and patient outcomes were analysed. RESULTS Of the 327 patients with pumps implanted, 24 evidenced EHP. The arterial branch responsible for EHP perfused the duodenum, pancreas and/or stomach. The branch responsible for EHP arose from the proper hepatic artery (PHA), 1(st) , 2(nd) , or 3(rd) order hepatic artery branches in 7, 10, 5 and 2 patients, respectively. The majority of branches beyond the PHA causing EHP (13/17) originated from the right hepatic artery. In 18 patients, aberrant branches were successfully treated with embolization. CONCLUSION These findings provide the anatomic basis for prevention of up to one-third of the cases of EHP intra-operatively, decreasing the number of patients who will require additional procedures for correction of EHP post-operatively.
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Affiliation(s)
- Daniel R Perez
- Department of Surgery, Memorial Sloan-Kettering Cancer CenterNew York, NY, USA
| | - Nancy E Kemeny
- Department of Medical Oncology, Memorial Sloan-Kettering Cancer CenterNew York, NY, USA
| | - Karen T Brown
- Department of Interventional Radiology, Memorial Sloan-Kettering Cancer CenterNew York, NY, USA
| | - Alexandra N Gewirtz
- Department of Medical Oncology, Memorial Sloan-Kettering Cancer CenterNew York, NY, USA
| | - Philip B Paty
- Department of Surgery, Memorial Sloan-Kettering Cancer CenterNew York, NY, USA
| | - William R Jarnagin
- Department of Surgery, Memorial Sloan-Kettering Cancer CenterNew York, NY, USA
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Karanicolas PJ, Metrakos P, Chan K, Asmis T, Chen E, Kingham TP, Kemeny N, Porter G, Fields RC, Pingpank J, Dixon E, Wei A, Cleary S, Zogopoulos G, Dey C, D'Angelica M, Fong Y, Dowden S, Ko YJ. Hepatic arterial infusion pump chemotherapy in the management of colorectal liver metastases: expert consensus statement. ACTA ACUST UNITED AC 2014; 21:e129-36. [PMID: 24523610 DOI: 10.3747/co.21.1577] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Despite significant improvements in systemic therapy for patients with colorectal liver metastases (crlms), response rates in the first-line setting are not optimal, and response rates in the second-line setting remain disappointing. Hepatic arterial infusion pump (haip) chemotherapy has been extensively studied in patients with crlms, but it remains infrequently used. We convened an expert panel to discuss the role of haip in the contemporary management of patients with crlm. Using a consensus process, we developed these statements: haip chemotherapy should be given in combination with systemic chemotherapy.haip chemotherapy should be offered in the context of a multidisciplinary program that includes expertise in hepatobiliary surgery, medical oncology, interventional radiology, nursing, and nuclear medicine.haip chemotherapy in combination with systemic therapy should be considered in patients with unresectable crlms who have progressed on first-line systemic treatment. In addition, haip chemotherapy is acceptable as first-line treatment in patients with unresectable colorectal liver metastases.haip chemotherapy is not recommended in the setting of extrahepatic disease outside the context of a clinical trial.haip chemotherapy in combination with systemic therapy is an option for select patients with resected colorectal liver metastases. These consensus statements provide a framework that clinicians who treat patients with crlm can use when considering treatment with haip.
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Affiliation(s)
- P J Karanicolas
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
| | - P Metrakos
- Quebec: Department of Surgery (Metrakos, Zogopoulos), McGill University, Montreal
| | - K Chan
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
| | - T Asmis
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
| | - E Chen
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
| | - T P Kingham
- New York State: Departments of Surgery (Kingham, Fong, D'Angelica) and Medicine (Kemeny), Memorial Sloan-Kettering Cancer Center, New York, NY, U.S.A
| | - N Kemeny
- New York State: Departments of Surgery (Kingham, Fong, D'Angelica) and Medicine (Kemeny), Memorial Sloan-Kettering Cancer Center, New York, NY, U.S.A
| | - G Porter
- Nova Scotia: Department of Surgery (Porter), Dalhousie University, Halifax
| | - R C Fields
- Missouri: Department of Surgery (Fields), Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis
| | - J Pingpank
- Pennsylvania: Department of Surgery (Pingpank), University of Pittsburgh, Pittsburgh
| | - E Dixon
- Alberta: Departments of Surgery (Dixon) and Medicine (Dowden), University of Calgary, Calgary
| | - A Wei
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
| | - S Cleary
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
| | - G Zogopoulos
- Quebec: Department of Surgery (Metrakos, Zogopoulos), McGill University, Montreal
| | - C Dey
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
| | - M D'Angelica
- New York State: Departments of Surgery (Kingham, Fong, D'Angelica) and Medicine (Kemeny), Memorial Sloan-Kettering Cancer Center, New York, NY, U.S.A
| | - Y Fong
- New York State: Departments of Surgery (Kingham, Fong, D'Angelica) and Medicine (Kemeny), Memorial Sloan-Kettering Cancer Center, New York, NY, U.S.A
| | - S Dowden
- Alberta: Departments of Surgery (Dixon) and Medicine (Dowden), University of Calgary, Calgary
| | - Y J Ko
- Ontario: Departments of Surgery (Karanicolas, Wei, Cleary), Medicine (Chan, Ko), and Medical Imaging (Dey), University of Toronto, Toronto; Departments of Surgery (Karanicolas), Medicine (Chan, Ko), and Medical Imaging (Dey), Sunnybrook Health Sciences Centre, Toronto; Departments of Medicine (Chen) and Surgery (Wei, Cleary), University Health Network, Toronto; Department of Medicine (Asmis), University of Ottawa, Ottawa
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Farouil G, Deschamps F, Barah A, Auperin A, Goere D, Elias D, de Baere T. Interventional revisions of malfunctions affecting surgically implanted port-catheters for hepatic artery infusion. Surg Oncol 2013; 22:48-54. [DOI: 10.1016/j.suronc.2012.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 10/03/2012] [Accepted: 10/06/2012] [Indexed: 01/07/2023]
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Stojković ML, Sobić-Saranović DP, Pavlović SV, Petrović MN, Stojković MV, Lukić SM, Radoman IB, Knezević SJ, Obradovic VB. Possible role of the scintigraphic estimation of the relative liver perfusion in the diagnosis and therapy of liver carcinomas. ACTA CHIRURGICA IUGOSLAVICA 2011; 58:33-38. [PMID: 21630550 DOI: 10.2298/aci1101033s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND The aim of the study is evaluation of the possible role of the scintigraphic estimation of the relative liver perfusion in diagnosis and the choice of treatment of liver carcinomas. MATERIAL AND METHODS Hepatic perfusion index was obtained by dynamic scintigraphy in 126 patients. RESULTS In the control group values did not differ from the value in the patients with benign tumors (p > 0.05). However, in hepatocellular carcinoma and liver metastases of different tumors, HPI values were significantly decreased in comparison to controls and benign tumors (p < 0.01), but they didn't differ between themselves (p > 0.05). The values were especially low in the patients with malignant diseases in the liver accosciated with vascular disturbances in the portal system. CONCLUSION HRA could be easily done during the different conventional nuclear medicine methods. It can be an useful method for the assessment of different degrees of hemodynamic alterations in portal system, for differential diagnosis of benign and malignant liver tumors, as well as for assessment of the liver tissue and tumor perfusion, which might be helpful in the decision making for the undertaking of intraarterial (radionuclide, chemotherapy etc.) therapy.
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Clinical rescue evaluation in laparoscopic surgery for hepatic metastases by colorectal cancer. Surg Laparosc Endosc Percutan Tech 2010; 20:69-72. [PMID: 20393330 DOI: 10.1097/sle.0b013e3181d83f02] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AIM Laparoscopy is an increasingly important tool in the staging and treatment for potentially resectable liver metastases. The clinical risk score (CRS) is useful in selecting patients for diagnostic laparoscopy before planning resection of colorectal metastases. This study evaluates the effect of staging laparoscopy (SL) combined with CRS. MATERIALS AND METHODS From January 2004 to December 2007, CRS evaluation and SL were performed in 65 consecutive patients with colorectal metastases, before planned open-exploration and resection. Patients were assigned to a CRS, which is based on 5 factors related to the primary tumor and the hepatic disease. This study was aimed at recognizing occult unresectable metastases, by combining laparoscopy and CRS. RESULTS Only 62 patients had a complete SL examination (3 were excluded for dense adhesions). A group of 24 patients was identified as unresectable, and 38 patients as resectable. In the latter group, 3 patients directly had laparoscopic treatment. In all, 38 patients underwent laparotomy (35 resectable, and 3 patients with dense adhesions that could not have a complete laparoscopic treatment).Resection was carried out in 30 of 38 (78.9%) cases, and the remaining 21% gave false-negative results. In all, there were 32 of 65 (49.2%) unresectable patients, and 75% of them were recognized by SL. CONCLUSIONS Laparoscopy identified the majority of patients with occult unresectable disease, improved resectability, and it should be a routine in patients being considered for potentially curative hepatic resection. The CRS, earlier shown to predict survival after hepatic resection, identifies high-risk patients, who are most likely to benefit from laparoscopy, and may improve resource utilization.
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Sameshima S, Horikoshi H, Motegi K, Tomozawa S, Hirayama I, Saito T, Sawada T. Outcomes of hepatic artery infusion therapy for hepatic metastases from colorectal carcinoma after radiological placement of infusion catheters. Eur J Surg Oncol 2007; 33:741-5. [PMID: 17399936 DOI: 10.1016/j.ejso.2007.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Accepted: 02/12/2007] [Indexed: 10/23/2022] Open
Abstract
AIM The aim of this study is to evaluate the safety and efficacy of hepatic artery infusion (HAI) of 5-fluorouracil (5FU) for patients with liver metastases from colorectal carcinoma after radiological placement of infusion catheters. METHODS Forty-two patients with liver metastases from colorectal carcinoma received radiological placement of infusion catheters using the distal fixation method. They received continuous HAI of 5FU 1,000-1,500mg for 5h weekly or biweekly. Tumor status was assessed by chest-abdominal computed tomography (CT) scan after every 10 infusions. Hepatic perfusion was checked by CT arteriography via the infusion port after every 10 infusions. RESULTS Radiological placements of catheters were performed successfully in all cases. Each patient received an average of 36 treatments (range: 10-98). Catheter failure was found in 3 patients (7.1%). Nine incidents of grade 1 toxicity were observed in 8 patients (19.0%). There was a complete response in 6 patients, partial remission in 18, stable disease in 9, and progression of disease in 9 (response rate: 57.1%). Overall median survival time was 29.1 months. Using Cox's proportional hazard model, lymph node metastases in primary colorectal carcinoma and pre-treatment serum CEA affected overall survival (P=0.011, P=0.005). CONCLUSIONS HAI after radiological placement of infusion catheters is a safe and effective treatment particularly for patients with no lymph node metastasis in primary carcinoma or with a low pre-treatment serum CEA level.
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MESH Headings
- Aged
- Angiography
- Antimetabolites, Antineoplastic/administration & dosage
- Antimetabolites, Antineoplastic/adverse effects
- Antimetabolites, Antineoplastic/therapeutic use
- Biomarkers, Tumor/blood
- Carcinoembryonic Antigen/blood
- Carcinoma/drug therapy
- Carcinoma/secondary
- Catheterization, Peripheral/adverse effects
- Catheterization, Peripheral/instrumentation
- Catheters, Indwelling/adverse effects
- Chemotherapy, Cancer, Regional Perfusion/instrumentation
- Colonic Neoplasms/pathology
- Disease Progression
- Female
- Fluorouracil/administration & dosage
- Fluorouracil/adverse effects
- Fluorouracil/therapeutic use
- Hepatic Artery
- Humans
- Infusion Pumps
- Liver Neoplasms/drug therapy
- Liver Neoplasms/secondary
- Male
- Radiography, Interventional
- Rectal Neoplasms/pathology
- Remission Induction
- Survival Rate
- Tomography, X-Ray Computed
- Treatment Outcome
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Affiliation(s)
- S Sameshima
- Department of Surgery, Gunma Prefectural Cancer Center, 617-1 Takabayashi-nishi, Ota, Gunma 373-8550, Japan.
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Proietti S, De Baere T, Bessoud B, Doenz F, Qanadli SD, Schnyder P, Denys A. Interventional management of gastroduodenal lesions complicating intra-arterial hepatic chemotherapy. Eur Radiol 2007; 17:2160-5. [PMID: 17219143 DOI: 10.1007/s00330-006-0552-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2006] [Revised: 09/24/2006] [Accepted: 11/28/2006] [Indexed: 10/23/2022]
Abstract
Herein we report the efficacy of embolization of small patent gastric or duodenal vessels for treating gastroduodenal complications after hepatic arterial infusion therapy (HAIC). Catheter ports were implanted percutaneously from a femoral approach in three cases or surgically in the gastroduodenal artery in two cases. Acute abdominal pain developed on average after four HAIC courses of 5FU-oxaliplatin, mytomycin, oxaliplatin or fotemustine. Esophagogastroduodenoscopy showed gastroduodenal lesions (gastroduodenitis with or without ulcerations) in all cases. Despite the interruption of the HAIC, symptoms persisted and led to selective hepatic arteriography showing a patent right gastric artery (n = 4) or a recanalized gastroduodenal artery (n = 1) responsible for gastroduodenal misperfusion. Successful embolizations of the arteries responsible for gastroduodenal misperfusion (right gastric artery in four cases and gastroduodenal artery in one case) using 0.018 platinium coils relieved the patients' symptoms and allowed the HAIC to continue. In gastroduodenal complications of HAIC, a selective hepatic arteriography should be performed to search any artery responsible for the misperfusion of the toxic agent in the gastroduodenal area. Embolization of these arteries allowed the HAIC to be restored.
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Affiliation(s)
- Stefania Proietti
- Department of Radiology, Centre Hospitalier , Universitaire Vaudois, 46 rue du Bugnon, 1011 Lausanne, Switzerland.
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