Technical complications and durability of hepatic artery infusion pumps for unresectable colorectal liver metastases: an institutional experience of 544 consecutive cases

J Am Coll Surg. 2005 Jul;201(1):57-65. doi: 10.1016/j.jamcollsurg.2005.03.019.


Background: Hepatic arterial infusion pump chemotherapy is an important component in the treatment of patients with hepatic metastases. Successful use of a hepatic arterial infusion pump requires a low technical complication rate. We evaluated the complications and longterm durability of these devices at our institution.

Study design: Between April 1986 and March 2001, 544 patients underwent hepatic arterial infusion pump placement for treatment of unresectable colorectal liver metastases. Patient- and pump-related data were collected by chart review. Pump-related complications, duration of pump function, and overall patient survival were recorded.

Results: Median patient survival was 24 months after pump placement. The incidences of pump failure were 9% at 1 year and 16% at 2 years. Pump complications occurred in 120 (22%) of the patients. Complications that occurred early after operation (< 30 days) were more likely to be salvaged than those occurring late (70% versus 30%, p < 0.001). Increased pump complication rates occurred in the setting of variant arterial anatomy (28% versus 19%, p = 0.02), when the catheter was inserted into a vessel other than the gastroduodenal artery (42% versus 21%, p = 0.004), if the pump was placed during the first half of the study period (1986 to 1993, 25% versus 1994 to 2001, 18%; p = 0.05), and if the surgeon had performed fewer than 25 earlier procedures (< 25, 31% versus > or = 25, 19%; p < 0.002).

Conclusions: In this large single institution experience, pump-related complications were low, the majority of early pump complications were salvaged, and pump complication rates improved as institutional experience accumulated. Longterm durability of pump function was excellent.

MeSH terms

  • Catheterization / instrumentation
  • Colectomy
  • Colorectal Neoplasms / pathology
  • Equipment Design
  • Equipment Failure
  • Female
  • Follow-Up Studies
  • Hepatic Artery* / pathology
  • Humans
  • Infusion Pumps, Implantable* / adverse effects
  • Length of Stay
  • Liver Neoplasms / drug therapy
  • Liver Neoplasms / secondary*
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Retrospective Studies
  • Survival Rate
  • Thrombosis / etiology
  • Time Factors