title: Techniques for the placement of hepatic artery catheters for regional chemotherapy in unresectable liver metastases.
abstract: OBJECTIVE
  For patients with unresectable liver metastases from colorectal cancer (CRC), hepatic artery infusion chemotherapy (HAIC) can produce higher response rates as compared to systemic chemotherapy. However, the added morbidity and early dysfunction after catheter placement have negatively influenced the outcomes of randomized studies.
  
  
  METHODS
  Between July 1998 and March 2006, 29 patients with unresectable liver metastases from CRC were included in three different HAIC protocols. A catheter was laparoscopically placed in the gastroduodenal artery, retrograde to the common hepatic artery and was attached to a subcutaneous access port. Perioperative parameters and catheter-associated adverse events during chemotherapy were studied.
  
  
  RESULTS
  Mean operating time was 106+/-29 min and median duration of hospitalization was 2 days (range: 1-13). No major perioperative complications occurred but there was 1 death (3.6%) 1 week after surgery due to hemorrhagic shock after necrosis and rupture of the hepatic artery. During a median follow-up of 10 months (range: 0-35) we observed 5 (17%) catheter-associated adverse events, but in only 2 patients (7%) this resulted in a loss of catheter function before the end of chemotherapy. Overall median duration of HAIC was 8 months (range: 1-28).
  
  
  CONCLUSIONS
  Laparoscopic placement of a hepatic artery catheter is associated with a low operative morbidity. The observed functionality of the hepatic artery ports in our series is encouraging for the use in future studies of HAIC.
authors.affiliation: Department of Surgery, Academisch Ziekenhuis, Vrije Universiteit Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium. hlkvney@az.vub.ac.be
authors.forename: Y
authors.initials: Y
authors.lastname: Van Nieuwenhove
authors.forename: M
authors.initials: M
authors.lastname: Aerts
authors.forename: B
authors.initials: B
authors.lastname: Neyns
authors.forename: G
authors.initials: G
authors.lastname: Delvaux
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002406:Catheterization, Peripheral / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents