Robotic-Assisted Placement of Hepatic Artery Infusion Pump for the Treatment of Colorectal Liver Metastases
Dr. Mario Spaggiari is a transplant and hepato-bilary pancreatic surgeon practicing in Chicago, IL. Dr. Spaggiari specializes in organ transplants including liver, pancreas, kidney and bowel; and oncologic surgeries for the treatment of complex liver, pancreas, and biliary system cancers and more. As a transplant and hepato-biliary... more
Surgical resection remains the only definitive treatment for colorectal liver metastasis (CRLM). However, only a minority of cases are deemed resectable at the time of diagnosis. Systemic chemotherapy along with hepatic artery infusion (HAI) is an effective and safe regional chemotherapy modality for the downstaging of patients with isolated unresectable CRLM. This modality improves patient response rate up to 80% and secondary resection rate up to 47% in isolated unresectable CRLM.
Although most patients with CRLM do not initially present as candidates for surgical resection, the combination of HAI directed regional chemotherapy and systemic chemotherapy has proven effective in downstaging stage IV cancer patients and bridging them to surgical resection. Downstaging with combination therapy could provide a more efficient way to select patients with tumor biology responsive to multimodal chemotherapy and surgical resection. Since liver metastases receive blood supply almost exclusively from the hepatic artery, direct chemotherapy through the hepatic artery allows an enhanced selective treatment delivery while limiting systemic side effects.
An HAI catheter placement with conventional laparoscopy is a tedious procedure requiring challenging vasculature dissection, accessible only to a few highly skilled laparoscopic surgeons. Robotic HAI pump placement is safe and associated with lower conversion rates and shorter length of stay in selected patients compared with laparoscopic placement.
In conclusion, the placement of an HAI pump using the robotic platform provides a minimally invasive option and minimal scarring to bridge patients to hepatic resection if downstaging is successful.
