Technical complications and durability of hepatic artery infusion pumps for unresectable colorectal liver metastases: an institutional experience of 544 consecutive cases.
BACKGROUND
Hepatic arterial infusion pump chemotherapy is an important component in the treatment of patients with hepatic metastases. Successful use of a hepatic arterial infusion pump requires a low technical complication rate. We evaluated the complications and longterm durability of these devices at our institution.


METHODS
Between April 1986 and March 2001, 544 patients underwent hepatic arterial infusion pump placement for treatment of unresectable colorectal liver metastases. Patient- and pump-related data were collected by chart review. Pump-related complications, duration of pump function, and overall patient survival were recorded.


RESULTS
Median patient survival was 24 months after pump placement. The incidences of pump failure were 9% at 1 year and 16% at 2 years. Pump complications occurred in 120 (22%) of the patients. Complications that occurred early after operation (< 30 days) were more likely to be salvaged than those occurring late (70% versus 30%, p < 0.001). Increased pump complication rates occurred in the setting of variant arterial anatomy (28% versus 19%, p = 0.02), when the catheter was inserted into a vessel other than the gastroduodenal artery (42% versus 21%, p = 0.004), if the pump was placed during the first half of the study period (1986 to 1993, 25% versus 1994 to 2001, 18%; p = 0.05), and if the surgeon had performed fewer than 25 earlier procedures (< 25, 31% versus > or = 25, 19%; p < 0.002).


CONCLUSIONS
In this large single institution experience, pump-related complications were low, the majority of early pump complications were salvaged, and pump complication rates improved as institutional experience accumulated. Longterm durability of pump function was excellent.
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY10021, USA.
Peter J
PJ
Allen
Aviram
A
Nissan
Antonio I
AI
Picon
Nancy
N
Kemeny
Paul
P
Dudrick
Leah
L
Ben-Porat
Joseph
J
Espat
Alexander
A
Stojadinovic
Alfred M
AM
Cohen
Yuman
Y
Fong
Philip B
PB
Paty
D002404:Catheterization / Q000295:instrumentation; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000473:pathology; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006499:Hepatic Artery / Q000473:pathology; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects; D007902:Length of Stay; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors