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Abstract
Background. Treatment regimens with hepatic arterial chemotherapy infusion are being investigated
in an attempt to improve survival and quality of life for patients with primary and
metastatic liver malignancies. The successful delivery of chemotherapeutic drugs through
an implantable hepatic arterial infusion device depends on the surgeon's understanding
of hepatic arterial anatomy, the proper cannulation technique, and the operative measures
necessary to prevent misperfusion of drug.
Methods. Between January 1, 1987, and December 31, 1991, we placed implantable hepatic arterial
infusion devices in 180 patients. The records of these patients were reviewed to determine
(1) the incidence and surgical management of variant hepatic arterial anatomy and
(2) the complications associated with surgical placement of these devices.
Results. Variant hepatic arterial anatomy requiring ligation of the variant vessel or nonstandard
cannulation was seen in 66 patients (36.7%). Treatment response rates and duration
of treatment were no different for these 66 patients than for the 114 patients with
standard hepatic arterial anatomy (p = 0.94). There were no operative deaths in this
series. Operative or early postoperative (within 30 days) complications occurred in
10 patients (5.5%). However, late complications or device-related malfunctions developed
in 52 patients (28.8%).
Conclusions. An understanding of regional arterial anatomy is required to surgically place a catheter
to achieve bilobar hepatic arterial perfusion and avoid gastroduodenal misperfusion
of drug. Placement of hepatic arterial infusion devices has a low rate of early morbidity,
but surgeons should be aware of late complications that may develop in patients undergoing
hepatic arterial chemotherapy infusion through an implantable device.
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Article info
Publication history
Accepted:
August 17,
1992
Identification
Copyright
© 1993 Published by Elsevier Inc.
