title: Placement of an arterial hepatic catheter after a major hepatectomy for colorectal liver metastases: is this safe?
abstract: BACKGROUND
  Studies have suggested that hepatic arterial infusion of chemotherapy (HAI) after resection of colorectal liver metastasis (CRLM) may improve patient's survival. The placement of a catheter in the hepatic artery at the time of hepatic surgery should therefore be considered in patients at high risk of hepatic recurrence. The aim of this study was to compare post-operative outcomes in patients who underwent at least a major hepatectomy (≥3 segments) for CRLM with or without catheter placement.
  
  
  METHODS
  From 2000 to 2010, 57 patients who underwent at least a major hepatectomy for CRLM resection were selected from a prospective database. Among them, 22 had had a catheter insertion during surgery.
  
  
  RESULTS
  The two groups were similar in terms of age, body mass index (BMI), ASA score, and the average number of pre-operative courses of systemic chemotherapy (11 ± 5). The rate of overall complications was slightly higher after catheter insertion (63% vs. 51%) although not significant (p = 0.36). Two patients had died post-operatively from liver insufficiency; both had undergone catheter insertion after a major hepatectomy associated with contralateral procedures resulting in a small remnant liver volume with low outflow capacity. Thrombosis of the common hepatic artery and portal venous gas were depicted on both CT scan.
  
  
  CONCLUSIONS
  Although the placement of an arterial catheter during a major hepatectomy does not significantly increase the rate of postoperative complications two patients died post-operatively in this study from vascular thrombosis. In case of extended and complex hepatectomy, with a higher risk of post-operative complications, delaying the catheter placement could be recommended.
authors.affiliation: Department of Surgical Oncology, Institut Gustave Roussy, 114 rue Edouard Vaillant, Villejuif Cedex, France.
authors.forename: L
authors.initials: L
authors.lastname: Benhaim
authors.forename: D
authors.initials: D
authors.lastname: Goéré
authors.forename: F
authors.initials: F
authors.lastname: Deschamps
authors.forename: F
authors.initials: F
authors.lastname: Dumont
authors.forename: S
authors.initials: S
authors.lastname: Bonnet
authors.forename: C
authors.initials: C
authors.lastname: Honoré
authors.forename: D
authors.initials: D
authors.lastname: Malka
authors.forename: V
authors.initials: V
authors.lastname: Boige
authors.forename: T
authors.initials: T
authors.lastname: De Baere
authors.forename: D
authors.initials: D
authors.lastname: Elias
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002408:Catheters, Indwelling / Q000009:adverse effects; D015179:Colorectal Neoplasms / Q000473:pathology*; D016208:Databases, Factual; D005260:Female; D006498:Hepatectomy; D006499:Hepatic Artery; D017052:Hospital Mortality; D006801:Humans; D007261:Infusions, Intra-Arterial; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D013927:Thrombosis / Q000209:etiology*; D016896:Treatment Outcome