Regional chemotherapy devices: effect of experience and anatomy on complications.
OBJECTIVE
Regional hepatic arterial infusion (HAI) devices have been used for 17 years, but reports of unacceptably high complication rates have led to controversy about their use. Inadequate or misdirected infusion has been reported to occur in up to 45% of patients. We evaluated whether surgeon experience or presence of variant arterial anatomy related to risk of coagulation.


METHODS
We reviewed 70 patients undergoing placement of HAI catheters. Surgeons were classed as experienced after 10 procedures and arterial anatomy was evaluated angiographically with confirmation at operation. Complications were categorized as technical (17%) or chemotherapy-related (16%).


RESULTS
Inexperienced surgeons had a technical complication rate of 37% (80% of the patients involved had standard anatomy), while experienced surgeons had a technical complication rate of 7% (P < .01). Experienced surgeons had no complications in patients with standard anatomy, while inexperienced surgeons had a 42% (eight of 19) complication rate in similar patients (P < .01).


CONCLUSIONS
We conclude that technical complications are closely associated with surgeon experience and arterial anatomy.
Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD.
K A
KA
Campbell
R C
RC
Burns
J V
JV
Sitzmann
P A
PA
Lipsett
L B
LB
Grochow
J E
JE
Niederhuber
D000328:Adult; D000704:Analysis of Variance; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy; D002408:Catheters, Indwelling / Q000009:adverse effects; D015179:Colorectal Neoplasms / Q000473:pathology; D005260:Female; D005467:Floxuridine / Q000008:administration & dosage / Q000009:adverse effects; D006499:Hepatic Artery / Q000033:anatomy & histology* / Q000601:surgery*; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D007431:Intraoperative Complications; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary; D008297:Male; D011361:Professional Competence; D013514:Surgical Procedures, Operative / Q000592:standards
D005467:Floxuridine