Pump removal in infected patients with hepatic chemotherapy pumps: when is it necessary?

Hepatic chemotherapy pumps have been shown to be an effective and well-tolerated treatment for metastatic colorectal cancer confined to the liver. The importance of completing chemotherapy in long-term outcome makes it desirable to salvage hepatic pumps where possible. Concerns of persistent and systemic infection have resulted in premature removal of pumps in patients with infection. We report our experience in this clinical scenario. We placed 75 hepatic chemotherapy pumps from January 1998 to August 2005 for treatment of colorectal liver metastases. Information was collected on the patients' courses of treatment, complications, and demographics via chart review. The rate of infection was 22.7% (n = 17), including eight infections localized to the abdomen (entailing five wound infections, three hepatic abscesses, and two pump pocket infections). Of these, two pumps had to be removed because of pump pocket infection, and these patients received more cycles of chemotherapy compared with the four removed for noninfectious complications (12.3 vs 3.2, P = 0.0349). Time to infection was found to be significantly higher in these patients (12.5 months) than in the patients with infections overall (4.87 months, P = 0.029), and age was found to be lower (42.5 vs 57.6 years, P = 0.0068).