Abstract
Liver malignancies are a major burden of disease worldwide. The long-term prognosis for patients with unresectable tumors remains poor, despite advances in systemic chemotherapy, targeted agents, and minimally invasive therapies such as ablation, chemoembolization, and radioembolization. Thus, the demand for new and better treatments for malignant liver tumors remains high. Surgical isolated hepatic perfusion (IHP) has been shown to be effective in patients with various hepatic malignancies, but is complex, associated with high complication rates and not repeatable. Percutaneous isolated liver perfusion (PHP) is a novel minimally invasive, repeatable, and safer alternative to IHP. PHP is rapidly gaining interest and the number of procedures performed in Europe now exceeds 200. This review discusses the indications, technique and patient management of PHP and provides an overview of the available data.
Highlights
The liver is frequently affected by cancer
The use of cone-beam computed tomography (CT) is recommended as this improves the detection of vascular variants, extrahepatic enhancement, and extrahepatic vascular tumor supply [22,23,24,25,26]
Most studies on Percutaneous hepatic perfusion (PHP) have been conducted in patients with liver metastases from ocular melanoma
Summary
The liver is frequently affected by cancer. Primary liver cancer is the sixth most common cancer in the world and the third cause of cancer-related death [1]. Liver malignancies have a dominant or exclusive vascular supply from the hepatic artery, whereas 70–80 % of the supply of the non-tumorous liver parenchyma is derived from the portal vein [3, 4]. This difference in perfusion is utilized in liver-directed therapies, such as trans-arterial (chemo-) embolization or radioembolization. The unique hepatic anatomy allows vascular isolation of the liver to deliver high doses of cytotoxic agents with minimal systemic toxicity. Promising results have been obtained with IHP in treating liver tumors from
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