title: Safety and optimal management of hepatic arterial infusion chemotherapy after pancreatectomy for pancreatobiliary cancer.
abstract: OBJECTIVE
  The purpose of this study was to assess the safety of hepatic arterial infusion (HAI) chemotherapy after pancreatectomy for pancreatobiliary cancer.
  
  
  METHODS
  The study subjects comprised 51 patients treated with HAI chemotherapy after pancreatectomy: 31 patients had undergone pancreaticoduodenectomy or total pancreatectomy and 20 patients had undergone distal pancreatectomy. HAI chemotherapy was performed for the prevention of liver metastasis in 42 patients and for the treatment of metastases in nine patients. HAI chemotherapy consisted of 5-fluorouracil administered at 1000 mg/m(2)/wk. After each cycle of chemotherapy, the patency of the hepatic artery and complications were evaluated using digital subtraction angiography and CT arteriography via the catheter-port system.
  
  
  RESULTS
  Placement of the catheter-port system was successful in all patients. Hepatic arterial occlusion and severe asymptomatic hepatic artery stenosis were observed in one patient (2%) and 10 patients (19.6%), respectively. The hepatic arterial patency rate tended to be lower in the group who underwent pancreaticoduodenectomy or total pancreatectomy (71%) than in the group who underwent distal pancreatectomy (90%), although the difference was not significant (p = 0.107). Four asymptomatic patients with hepatic artery stenosis restarted HAI chemotherapy after a 4-week withdrawal of treatment. In three patients (5.9%), all of whom had undergone pancreaticoduodenectomy, liver abscess or biloma developed synchronously with asymptomatic hepatic artery stenosis. All three cases were cured by percutaneous abscess drainage or conservative management. The tumor response rate in the treatment of liver metastases was 44.4%. The hepatic recurrence rate with adjuvant therapy was 7.1%.
  
  
  CONCLUSIONS
  Our findings suggest that HAI chemotherapy after pancreatectomy is feasible and tolerable, although caution is required particularly after pancreaticoduodenectomy or after total pancreatectomy.
authors.affiliation: Department of Radiology, Nara Medical University, Kashihara City, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Hashimoto
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Nishiofuku
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Tanaka
authors.forename: Masayuki
authors.initials: M
authors.lastname: Sho
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Anai
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Nakajima
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Kichikawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D001661:Biliary Tract Neoplasms / Q000188:drug therapy* / Q000601:surgery; D016009:Chi-Square Distribution; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage*; D006499:Hepatic Artery; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D061214:Patient Safety; D016896:Treatment Outcome
chemical_list: D005472:Fluorouracil