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

Abstract

Background: Hepatic arterial infusion pump (HAIP) therapy for colorectal liver metastases (CRLM) is beneficial yet wide acceptance in the oncology community is lacking. We describe early outcomes for a surgeon-led HAIP program. Methods: A team of pharmacists, oncology nursing and surgical oncologists implemented a HAIP program at a tertiary cancer hospital. Pumps were placed by laparotomy with or without curative resection for CRLM in 60 patients from 11/2012 to 4/2016. FUDR (Fluorodeoxyuridine) was infused via HAIP every 28 days supervised by the operating surgeon. Overall patient management was a joint effort between medical and surgical oncology. Results: Indications for HAIP therapy were adjuvant after resection of CRLM in 26 (43%) patients and unresectable disease in 34 (57%). All had prior systemic chemotherapy (FOLFOX in 81%). Perioperative complications occurred in 19 (32%), serious complications in 6 (10%) and intrahepatic biliary strictures in one patient (1.6%). Median number of FUDR cycles was five and median follow-up 22 months. Median time to progression in the unresectable group was 5.6 months, and time to recurrence in the adjuvant group was 9.4 months. Estimated 3-year overall survival from the time of HAIP placement was 56% in the adjuvant group and 42% in the unresectable group (Figure 1). Worse survival was associated with more than one line of prior chemotherapy (HR 2.3, CI 1.3–4.2), largest tumor size (HR 1.3, 1.1–1.7) and visceral to subcutaneous fat ratio (HR 17.4, 3.5–85.3). Sarcopenia was associated with post-operative complications but not survival. Conclusion: Surgeons play a valuable role in CRLM even when incurable. A surgeon-led HAIP program may achieve outcomes on par with those of experienced centers. Such programs foster strong relationships between surgical and medical oncologists for true multidisciplinary care.