Laparoscopic Placement of Hepatic Artery Infusion Pumps: Technical Considerations and Early Results

Cheng, Jun; Hong, Dennis; Zhu, Guojing; Swanström, Lee L.; Hansen, Paul

doi:10.1245/aso.2004.05.013

Cited by 23 publications

(14 citation statements)

References 20 publications

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“…One avenue of potential study involves the implantation of the infusion pump and whether implantation could be accomplished using a less invasive technique. Several alternatives to laparotomy have been explored, including laparoscopy, robot-assisted techniques, and percutaneous approaches [60][61][62][63][64][65][66][67][68] . All the techniques have clear advantages over the conventional approach, but none has demonstrated consistently acceptable results with respect to pump function and complication rates.…”

Section: Areas Of Future Studymentioning

confidence: 99%

Hepatic arterial infusion pump chemotherapy in the management of colorectal liver metastases: expert consensus statement

Karanicolas¹,

Metrakos²,

Chan³

et al. 2013

Curr. Oncol.

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KEY WORDSColorectal metastases, liver metastases, unresectable metastases, adjuvant chemotherapy, intraarterial chemotherapy, hepatic arterial infusion pump chemotherapy BACKGROUNDOver the past several years, important progress has been made in the treatment of patients with metastatic colorectal cancer. Median overall survival in these patients now extends beyond 2 years with a combination of modern systemic therapies [1][2][3][4][5][6][7][8] . Approximately 60% of patients present with liver-only or liver-predominant metastases, and if complete surgical resection is achieved in those patients, 5-year overall survival approaches 50% 9-11 . In patients with initially unresectable colorectal liver metastases (crlms), systemic therapy can, in up to 30% of patients, produce a tumour response sufficient to allow for resection and the possibility of long-term survival or cure 12,13 . An important goal of aggressive therapy in patients with initially unresectable crlms is therefore conversion to resectability.Although the response rate to systemic therapy is good in untreated patients, response rates to chemotherapy in the second-line setting remain disappointing. The most encouraging results are obtained with the addition of biologic agents to chemotherapy, achieving response rates of up to 20%-35% and a corresponding median survival of up to 1 year in the second-line setting [14][15][16][17][18] . Given the limited efficacy of systemic therapy beyond the first-line setting, patients could benefit from other treatments that would increase response and resectability rates.Hepatic arterial infusion pump (haip) chemotherapy has been extensively studied in patients with crlms. The rationale for arterial delivery of 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 pati...

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Section: Areas Of Future Studymentioning

confidence: 99%

Hepatic arterial infusion pump chemotherapy in the management of colorectal liver metastases: expert consensus statement

Karanicolas¹,

Metrakos²,

Chan³

et al. 2013

Curr. Oncol.

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“…13–17 In this report, we provide a descriptive analysis of our series of robotic HAIP placements with a comparison to our open and laparoscopic experience at the MSKCC.…”

Section: Introductionmentioning

confidence: 99%

Robotic hepatic arterial infusion pump placement

Qadan

D’Angelica

Kemeny

et al. 2017

HPB

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Introduction Hepatic artery infusion pump (HAIP) placement is associated with improved outcomes in the treatment of colorectal liver metastases (CRLM). In this study, we examined outcomes following robotic HAIP placement, which were compared with open and laparoscopic placement. Methods A retrospective review of HAIP placements by 2 surgeons at a single institution was carried out from a prospectively maintained institutional cancer database. The institutional review board approved this HIPAA-compliant study. All statistical tests were 2-sided and p < 0.05 was considered significant. Results There were a total of 53 open HAIP cases, 21 laparoscopic cases, and 24 robotic cases. There were no statistically significant differences between the 3 groups in gender, age, body mass index, aberrant arterial anatomy, disease process being treated, or prior treatment, including chemotherapy, or prior abdominal or hepatic surgical intervention (p > 0.05). Robotic HAIP placement was associated with a significantly lower conversion rate to open operation than laparoscopic pump placement (17 vs. 67%; p = 0.0009). When cases with concomitant resections were excluded, there was a trend towards shorter median length of hospital stay with robotic pump placement compared with open and laparoscopic placement (4 vs. 5 vs. 5 days, respectively; p = 0.09). Complication rates were equivalent among the 3 groups when concomitant resections were excluded. Conclusion Robotic HAIP placement is a safe minimally-invasive procedure that is associated with a significantly lower conversion rate to open operation compared with laparoscopic placement and a trend towards shorter hospitalization compared to open.

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“…A minimally invasive pump placement using conventional laparoscopic techniques has been described in the literature [9][10][11][12]. Franklin et al reported a series of 20 laparoscopic pump placements during concurrent major laparoscopic procedures with no conversions and no intraoperative complications [10].…”

Section: Discussionmentioning

confidence: 99%

“…Franklin et al reported a series of 20 laparoscopic pump placements during concurrent major laparoscopic procedures with no conversions and no intraoperative complications [10]. Hansen et al reported one conversion due to dense adhesions, no intraoperative complications, and three catheter thromboses in a series of 38 patients [9]. The placement of a hepatic artery infusion catheter with conventional laparoscopic techniques is technically a very challenging procedure.…”

Section: Discussionmentioning

confidence: 99%

“…The assistant injected 5 ml of methylene blue in 10 ml of normal saline into the pump to assess for complete hepatic perfusion intraoperatively, and to exclude accidental perfusion onto non-hepatic tissue such as the duodenum or the stomach. If incomplete hepatic perfusion is found, accessory or replaced hepatic arteries should be ligated and divided as necessary [9]. Any detected misperfusion of stomach or duodenum requires further intraoperative devascularization.…”

Section: Placement Of Pump and Cathetermentioning

confidence: 99%

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Robotic-assisted placement of a hepatic artery infusion catheter for regional chemotherapy

Hellan

Pigazzi

2007

Surg Endosc

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Hepatic arterial infusion chemotherapy can be of value to patients with metastatic liver disease from colorectal cancer. Arterial infusion therapy requires surgical placement of a catheter into the gastroduodenal artery connected to a subcutaneous infusion pump or port, a procedure involving major abdominal surgery. Placement of chemotherapy infusion catheters by conventional laparoscopic techniques has been described, but is a technically challenging procedure. The purpose of this report is to introduce a new, minimally invasive approach for hepatic artery catheter placement using the DaVinci robotic system with the potential to minimize surgical trauma, pain, and hospital stay, and to render this minimal access procedure more feasible and widely applicable.

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Laparoscopic Placement of Hepatic Artery Infusion Pumps: Technical Considerations and Early Results

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

Cited by 23 publications

References 20 publications

Hepatic arterial infusion pump chemotherapy in the management of colorectal liver metastases: expert consensus statement

Hepatic arterial infusion pump chemotherapy in the management of colorectal liver metastases: expert consensus statement

Robotic hepatic arterial infusion pump placement

Robotic-assisted placement of a hepatic artery infusion catheter for regional chemotherapy

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