Implementation and early outcomes for a surgeon-directed hepatic arterial infusion pump program for colorectal liver metastases

Autor: Gail W. Davidson, Mary Dillhoff, Eliza W. Beal, Sherif Abdel-Misih, Mark Bloomston, Steven Sun, Aaron Chafitz, Joshua Reardon, Timothy M. Pawlik, Jason Galo, Jeffery Chakedis, Carl Schmidt
Rok vydání: 2018
Předmět:
Zdroj: Journal of Surgical Oncology. 118:1065-1073
ISSN: 0022-4790
DOI: 10.1002/jso.25249
Popis: 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.
Databáze: OpenAIRE
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