Abstract
BackgroundThe 10-year overall survival with adjuvant hepatic arterial infusion pump (HAIP) chemotherapy after resection of colorectal liver metastases (CRLMs) was 61% in clinical trials from Memorial Sloan Kettering Cancer Center. A pilot study was performed to evaluate the safety and feasibility of adjuvant HAIP chemotherapy in patients with resectable CRLMs.Study DesignA phase II study was performed in two centers in The Netherlands. Patients with resectable CRLM without extrahepatic disease were eligible. All patients underwent complete resection and/or ablation of CRLMs and pump implantation. Safety was determined by the 90-day HAIP-related postoperative complications from the day of pump placement (Clavien–Dindo classification, grade III or higher) and feasibility by the successful administration of the first cycle of HAIP chemotherapy.ResultsA total of 20 patients, with a median age of 57 years (interquartile range [IQR] 51–64) were included. Grade III or higher HAIP-related postoperative complications were found in two patients (10%), both of whom had a reoperation (without laparotomy) to replace a pump with a slow flow rate or to reposition a flipped pump. No arterial bleeding, arterial dissection, arterial thrombosis, extrahepatic perfusion, pump pocket hematoma, or pump pocket infections were found within 90 days after surgery. After a median of 43 days (IQR 29–52) following surgery, all patients received the first dose of HAIP chemotherapy, which was completed uneventfully in all patients.ConclusionPump implantation is safe, and administration of HAIP chemotherapy is feasible, in patients with resectable CRLMs, after training of a dedicated multidisciplinary team.
Highlights
The 10-year overall survival with adjuvant hepatic arterial infusion pump (HAIP) chemotherapy after resection of colorectal liver metastases (CRLMs) was 61% in clinical trials from Memorial Sloan Kettering Cancer Center
Patients were excluded if positioning of a catheter for HAIP chemotherapy was not feasible based on a preoperative arterial computed tomography (CT) scan, prior hepatic radiation or resection, CRLM requiring twostaged resection, liver-first approach, and diagnosis of another malignancy
Two patients were excluded during surgery; one patient had unresectable CRLMs found during intraoperative ultrasonography, and one patient was excluded due to an occult peritoneal lesion that was found during surgery and confirmed by frozen section biopsy
Summary
The 10-year overall survival with adjuvant hepatic arterial infusion pump (HAIP) chemotherapy after resection of colorectal liver metastases (CRLMs) was 61% in clinical trials from Memorial Sloan Kettering Cancer Center. A pilot study was performed to evaluate the safety and feasibility of adjuvant HAIP chemotherapy in patients with resectable CRLMs. Study Design. Patients with resectable CRLM without extrahepatic disease were eligible. All patients underwent complete resection and/or ablation of CRLMs and pump implantation. Safety was determined by the 90-day HAIP-related postoperative complications from the day of pump placement (Clavien–Dindo classification, Recurrent disease is reported in up to 70% of patients after resection of colorectal liver metastases (CRLMs).. Reported 5- and 10-year overall survival (OS) of CRLM patients treated with resection and systemic chemotherapy were 40% and 25%, respectively. Safety was determined by the 90-day HAIP-related postoperative complications from the day of pump placement (Clavien–Dindo classification, Recurrent disease is reported in up to 70% of patients after resection of colorectal liver metastases (CRLMs). Reported 5- and 10-year overall survival (OS) of CRLM patients treated with resection and systemic chemotherapy were 40% and 25%, respectively.
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