Extrahepatic perfusion and incomplete hepatic perfusion after hepatic arterial infusion pump implantation: incidence and clinical implications
Year: 2024
Type: article
Study design: Observational Study
Abstract: Introduction This study investigates the incidence of extrahepatic perfusion and incomplete hepatic perfusion at intraoperative methylene blue testing and on postoperative nuclear imaging in patients undergoing hepatic arterial infusion pump (HAIP) chemotherapy. Methods The first 150 consecutive patients who underwent pump implantation in the Netherlands were included. All patients underwent surgical pump implantation with the catheter in the gastroduodenal artery. All patients underwent intraoperative methylene blue testing and postoperative nuclear imaging ( 99m Tc-Macroaggregated albumin SPECT/CT) to determine perfusion via the pump. Results Patients were included between January-2018 and December-2021 across eight centers. During methylene blue testing, 29.3% had extrahepatic perfusion, all successfully managed intraoperatively. On nuclear imaging, no clinically relevant extrahepatic perfusion was detected (0%, 95%CI: 0.0-2.5%). During methylene blue testing, 2.0% had unresolved incomplete hepatic perfusion. On postoperative nuclear imaging, 8.1% had incomplete hepatic perfusion, leading to embolization in only 1.3%. Conclusion Methylene blue testing during pump placement for intra-arterial chemotherapy identified extrahepatic perfusion in 29.3% of patients, but could be resolved intraoperatively in all patients. Postoperative nuclear imaging found no clinically relevant extrahepatic perfusion and led to embolization in only 1.3% of patients. The role of routine nuclear imaging after HAIP implantation should be studied in a larger cohort.
Source: HPB
Authors: Wills F. Filipe, Florian E. Buisman, Stijn Franssen, Myrtle F. Krul, Dirk J. Grünhagen, Roel J. Bennink, Karen Bolhuis, Rutger C.G. Bruijnen, Tineke E. Buffart, Mark C. Burgmans, Otto M. van Delden, Pascal G. Doornebosch, Paul D. Gobardhan, Laura Graven, Jan Willem B. de Groot, Cecile Grootscholten, Jeroen Hagendoorn, Paul Harmsen, Marjolein Y.V. Homs, Elizabeth G. Klompenhouwer, Niels F.M. Kok, Marnix G.E.H. Lam, Olaf J.L. Loosveld, Mark A.J. Meier, J. Sven D. Mieog, Ad H.J. Oostdijk, Loubna Outmani, Gijs A. Patijn, Stefan Pool, Daphne D.D. Rietbergen, Jeanine M.L. Roodhart, Frank M. Speetjens, Rutger Jan Swijnenburg, Michelle W.J. Versleijen, Cornelis Verhoef, Koert F.D. Kuhlmann, Adriaan Moelker, Bas Groot Koerkamp, Wills F. Filipe, Florian Buismanz Buisman, Bas Groot Koerkamp, Dirk J. Grunhagen, Marjolein Y.V. Homs, Cornelis Verhoef, Adriaan Moelker, Laura Graven, Stijn Franssen, Paul D. Gobardhan, Olaf J.L. Loosveld, Stefan Pool, J. Sven D. Mieog, Frank M. Speetjens, Daphne D.D. Rietbergen, Mark C. Burgmans, Pascal G. Doornesbosch, Gijs A. Patijn, Jan Willem B. de Groot, Mark A.J. Meier, Ad H.J. Oostdijk, Karen Boluis, Cecile Grootscholten, Elizabeth G. klompenhouwer, Niels F.M. Kok, Koert, F.D. kuhlmann, Myrtle F. Krul, Michelle W.J. Versleijen, Rutger C.G. Bruijnen, Jroen Hagendoorn, Marnix G.E.H. Lam, Jeanine M.L. Roodhart, Roel J. Bennink, Otto M. van Delden, Rutger-Jan Swijnenburg, Tineke E. Buffart, Inne H.M. Borel Rinkes, Andrea Cercek, Nancy E. Kemeny, T. Peter Kingham, Michael D’Angelica, Christian P.H. van Bommel, Leni van Doorn, Ninos Ayez, Maarten Vermaas, Vincent B. Nieuwenhuijse
Institutions: Erasmus MC Cancer Institute, Erasmus University Rotterdam, The Netherlands Cancer Institute, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, University Medical Center Utrecht, Leiden University Medical Center, IJsselland Ziekenhuis, Amphia Ziekenhuis, Erasmus MC, Isala
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,630
Funder: KWF Kankerbestrijding
OpenAlex ID: W4392973943