title: Percutaneous vs. surgical placement of hepatic artery indwelling catheters for regional chemotherapy.
abstract: OBJECTIVE
  Intra-arterial hepatic chemotherapy based on floxuridine infusion is an effective treatment for hepatic metastases from colorectal cancer. The aim of the present study is the comparative analysis of surgical and percutaneous transaxillary approaches to implant a catheter into the hepatic artery for intra-arterial hepatic chemotherapy with floxuridine.
  
  
  METHODS
  Fifty-six patients received an arterial device for intra-arterial hepatic chemotherapy. Twenty-eight patients (LPT group) underwent laparotomy to implant the catheter into the hepatic artery, the other 28 patients (PCT group) received a percutaneous catheter into the hepatic artery through a transaxillary percutaneous access. Safety and efficacy of surgical and percutaneous transaxillary approaches were comparatively analyzed in terms of number of intra-arterial hepatic chemotherapy cycles administered, device-related complications causing suppression of intra-arterial hepatic chemotherapy, and biological costs of the procedures.
  
  
  RESULTS
  Mean postoperative hospitalization was 8.2 +/- 2.2 days in the LPT group and 1.8 +/- 0.7 days in the PCT group (P < 0.0001), while mean analgesic requirements were 9.7 +/- 3.2 doses in the LPT group and 2 +/- 0.9 doses in the PCT group (P < 0.0001). Mean number of intra-arterial hepatic chemotherapy cycles administered was 6.5 +/- 4.2 in the LPT group and 4.3 +/- 3.4 in the PCT group (P = 0.038). The overall incidence of device-related complications causing suppression of intra-arterial hepatic chemotherapy was 42.7% in the PCT group and 7.1% in the LPT group (P = 0.005).
  
  
  CONCLUSIONS
  Surgical implantation is still recommended when laparotomy has to be performed for other contextual procedures, such as colorectal or hepatic resection, while percutaneous transaxillary catheter placement is indicated for palliative or neoadjuvant intra-arterial hepatic chemotherapy.
authors: Department of Surgery, Scientific Institute H San Raffaele, Vita-Salute San Raffaele University, Milan, Italy. aldrighetti.luca@hsr.it
authors: Luca
authors: L
authors: Aldrighetti
authors: Marcella
authors: M
authors: Arru
authors: Enzo
authors: E
authors: Angeli
authors: Massimo
authors: M
authors: Venturini
authors: Marco
authors: M
authors: Salvioni
authors: Monica
authors: M
authors: Ronzoni
authors: Roberto
authors: R
authors: Caterini
authors: Gianfranco
authors: G
authors: Ferla
mesh_terms: D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage*; D002408:Catheters, Indwelling; D015179:Colorectal Neoplasms / Q000473:pathology; D005260:Female; D005467:Floxuridine / Q000008:administration & dosage*; D006499:Hepatic Artery; D006801:Humans; D015918:Infusion Pumps, Implantable; D007261:Infusions, Intra-Arterial; D007813:Laparotomy; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary; D008297:Male; D008875:Middle Aged
chemical_list: D000964:Antimetabolites, Antineoplastic; D005467:Floxuridine