A simplified surgical technical procedure for intra-arterial chemotherapy in secondary liver cancer. Experience in 50 patients.

The purpose of this study was to prove that only one intra-arterial catheter for hepatic chemotherapy can perfuse the whole liver in all anatomic cases, including cases with aberrant or accessory hepatic arteries. The ligations of various hepatic arteries induce the immediate aperture of intra hepatic arterial shunts and a total revascularization of the whole liver by the only remaining hepatic artery. Based on the experience from 50 consecutive cases of surgical implantation of intra-arterial catheters for local chemotherapy, the simplified technique is analysed principally as a function of anatomical variations of the hepatic artery. The usual procedure (catheter implanted into the gastro-duodenal artery) was performed in 58% of the cases, while in 28% of the cases this was possible only after section of a right and/or a left aberrant or accessory hepatic artery. Unusual implantations were necessary in 14% of the cases to ensure complete perfusion of liver. The evaluation was based on three criteria: intra-operative perfusion of fluorescein, post-operative scan with 99mTc macro-aggregated albumin and objective clinical responses after intra-arterial chemotherapy. The perfusion of the whole liver was good in all cases except one. Unusual procedures gave the same clinical objective responses after intra-arterial chemotherapy (61%) as usual procedures (48%) (chi-square: P = 0.40).