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Published on: January 25, 2015
Implementation and early outcomes for a surgeon-directed hepatic arterial infusion pump program for colorectal liver
Jeffery Chakedis1, Eliza W Beal1, Steven Sun1
1Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Arthur G. James Cancer Hospital and Solove Research Institute, Columbus, Ohio.
Insights
Hepatic arterial infusion pump (HAIP) therapy can achieve good outcomes for colorectal liver metastases (CRLM). A surgeon-led program demonstrated survival rates comparable to experienced centers, highlighting its potential in selected patients.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Hepatic arterial infusion pump (HAIP) therapy shows promise for colorectal liver metastases (CRLM).
- Widespread adoption of HAIP for CRLM is limited within the oncology community.
- Establishing effective HAIP programs requires careful consideration of patient selection and program implementation.
Purpose of the Study:
- To evaluate the outcomes of a surgeon-led Hepatic Arterial Infusion Pump (HAIP) program for colorectal liver metastases (CRLM).
- To assess the feasibility and efficacy of HAIP in both adjuvant and unresectable CRLM settings.
- To determine the impact of sarcopenia on survival in patients treated with HAIP.
Main Methods:
- A dedicated HAIP program was initiated by a surgeon-led team in 2012.
- Sixty patients with CRLM were treated using HAIP with fluorodeoxyuridine infusion every 28 days.
- Treatment was administered in either the adjuvant setting (post-resection/ablation) or for unresectable disease, without concurrent systemic chemotherapy.
Main Results:
- Sixty patients received HAIP, with 26 in the adjuvant group and 34 with unresectable disease.
- Perioperative complications occurred in 32% and pump-specific complications in 23% of patients.
- Median time to liver progression was 9.2 months (unresectable) and 24.7 months (adjuvant). Estimated 3-year overall survival was 37% (unresectable) and 64% (adjuvant).
- Sarcopenia was observed in 48% of patients and was linked to poorer survival (HR 2.4).
Conclusions:
- A surgeon-led HAIP program can achieve outcomes comparable to those at experienced centers.
- Such programs can strengthen collaborations between surgical and medical oncologists.
- HAIP represents a viable treatment option for selected CRLM patients, particularly when managed by a dedicated surgical team.
Introduction:
Hepatic arterial infusion pump (HAIP) therapy for colorectal liver metastases (CRLM) is beneficial in selected patients yet wide acceptance in the oncology community is lacking.
Methods:
A surgeon-led team implemented a HAIP program in 2012. Pumps were placed by laparotomy for CRLM and fluorodeoxyuridine was infused via HAIP every 28 days without systemic chemotherapy supervised by the operating surgeon.
Results:
Sixty patients were treated with HAIP, either in the adjuvant setting after liver resection or ablation of CRLM in 26 (43%) patients or with the unresectable disease in 34 (57%). Perioperative complications occurred in 19 (32%) and pump-specific complications in 14 (23%) that included intrahepatic biliary stricture in one (2%). Time to liver progression was a median 9.2 months (95% CI, 3.1-15.3 months) in unresectable patients and liver recurrence was a median 24.7 months (2.5-46.9 months) in the adjuvant group. Estimated 3-year overall survival from the time of HAIP placement was 64% in the adjuvant group and 37% in the unresectable group. Sarcopenia was prevalent (48%) and was associated with a worse survival (HR 2.4, 95% CI, 1.1-5.0).
Conclusion:
A surgeon-led HAIP program may achieve outcomes on par with those of experienced centers and foster strong relationships between surgical and medical oncologists.
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