Isolated Hypoxic Hepatic Perfusion with Retrograde Outflow in Patients with Irresectable Liver Metastases; A New Simplified Technique in Isolated Hepatic PerfusionReportar como inadecuado




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Annals of Surgical Oncology

, Volume 15, Issue 5, pp 1367–1374

First Online: 01 February 2008Received: 27 June 2007Revised: 30 October 2007Accepted: 31 October 2007

Abstract

BackgroundIsolated hepatic perfusion with high-dose chemotherapy is a treatment option for patients with irresectable metastases confined to the liver. Prolonged local control and impact on survival have been claimed. Major drawbacks are magnitude and costs of the procedure. We developed an isolated hypoxic hepatic perfusion IHHP with retrograde outflow without the need for a heart-lung machine.

Patients and MethodsTwenty-four consecutive patients with irresectable metastases of various origins were treated. IHHP inflow was via the hepatic artery, outflow via the portal vein with occlusion of the retrohepatic caval vein. Radiolabeled albumine was used for leakage monitoring. Melphalan was used at 1–2 mg-kg. A 25-minute perfusion period was followed by a complete washout. Local and systemic melphalan concentrations were determined.

ResultsCompared with oxygenated classical IHP, the IHPP procedure reduced operation time from >8 h to 4 hours, blood loss from >4000 to 900 cc and saved material and personnel costs. Leakage was 0% with negligible systemic toxicity and 0% perioperative mortality. Tumor response: complete response CR in 4%, partial response PR in 58%, and stable disease SD in 13%. Median time to progression was 9 months 2–24 months; pharmacokinetics demonstrated intrahepatic melphalan concentrations more than 9 fold higher than postperfusion systemic concentrations.

ConclusionsIHPP is a relatively simple procedure with reduced costs, reduced blood loss, no mortality, limited toxicity, and response rates comparable to classic IHP. The median duration of 9 months of tumor control should be improved. Hereto, vasoactive drugs, will be explored in further studies.

KeywordsIsolated hepatic perfusion Retrograde outflow Hypoxic Metastasis Melphalan  Download fulltext PDF



Autor: Cornelis Verhoef - Johannes H. W. de Wilt - Flavia Brunstein - Andreas W. K. S. Marinelli - Boudewijn van Etten - Maar

Fuente: https://link.springer.com/article/10.1245/s10434-007-9714-z







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