Long-term hepatic arterial infusion chemotherapy. Anatomic considerations, operative technique, and treatment morbidity.

Disappointment with the results of systemic chemotherapy for treatment of colorectal hepatic metastases has led to renewed interest in hepatic arterial infusion chemotherapy. Forty adult patients underwent preoperative examination, operative staging of the extent of liver involvement, and surgical placement of an implantable pump with the catheter in the hepatic arterial system. Twenty-one patients were previously untreated. Hepatic involvement ranged from 15% to 85%; none of the patients had unresectable extrahepatic disease. Operative complications occurred in 10% of the patients; there were no deaths. Treatment morbidity consisted of gastrointestinal tract inflammation and/or ulceration (48%) and hepatitis (65%). Partial tumor responses occurred in nine of 18 previously untreated patients and five of 16 previously treated patients. Use of an implantable pump for long-term hepatic arterial chemotherapy was associated with improved patient acceptance, minimal operative morbidity, and substantial tumor response to chemotherapy.