Modified hepatic arterial infusion chemotherapy protocol for reducing perioperative pain and anesthetic consumption in patients with hepatocellular carcinoma
Year: 2025
Type: article
Abstract: Background: Hepatic arterial infusion chemotherapy (HAIC) with the FOLFOX (folinic acid + fluorouracil + oxaliplatin) regimen has emerged as a crucial treatment for advanced hepatocellular carcinoma (HCC), but oxaliplatin-induced neuropathic pain significantly reduces patients' quality of life. This study investigated the impact of modified HAIC procedures on perioperative pain levels and analgesic requirements in patients with HCC. Methods: This single-institution retrospective study analyzed 180 patients with HCC undergoing HAIC. Patients were divided into three groups: Group A (n=40), which received the standard FOLFOX-HAIC regimen; Group B (n=74), which received a reverse sequence FOLFOX-HAIC (REFOLFOX-HAIC), with oxaliplatin administered after fluorouracil and leucovorin; and Group C (n=67), which received a direct intraoperative infusion of oxaliplatin with FOLFOX-HAIC (OxDirect-FOLFOX-HAIC). The primary endpoints were the intraoperative and 24-hour postoperative analgesic utilization score and visual analogue scale (VAS) pain scores. Secondary outcomes included tumor response and safety. Results: 98.51%; P=0.591). The safety profiles were comparable, with no grade-3-or-higher adverse events reported. Conclusions: The REFOLFOX-HAIC and OxDirect-FOLFOX-HAIC procedures significantly reduced perioperative pain and the need for analgesics in patients with HCC as compared to the conventional FOLFOX-HAIC protocol, without compromising short-term tumor control or safety.
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4414483834
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