The implanted pump in metastatic colorectal cancer of the liver: risk versus benefit

Forty patients with colorectal cancer metastatic to the liver were treated with an implanted pump for hepatic artery perfusion. Regional chemotherapy utilized floxuridine with half of patients also receiving monthly cisplatin. Follow-up was 13 to 29 months. Responses to treatment occurred in 19 patients (47 percent) and correlated with survival of more than 1 year. Several factors produced significant reductions in survival: presence of extrahepatic disease, large tumor volume, jaundice, ascites, or both, and elevated liver chemistry values. These prognostic factors should govern patient selection. Toxicity included gastritis, peptic ulcer, disruption of arterial integrity, and severe chemical effects on the hepatic cells, the bile ducts, and the gallbladder. Over half of the patients had serious toxicity. Two died from biliary strictures without autopsy evidence of tumor. Steps to avoid life-threatening toxicity include ligation of all hepatic artery branches to the stomach, prophylactic cholecystectomy, and reduction of chemotherapy at the first sign of toxicity.