Some cancers begin in the liver. But other liver cancers occur when cancer spreads (metastasizes) to the liver from another part of your body. When this happens, metastatic liver cancer, also known as secondary liver cancer, results.

A study published in a 2021 issue of Translational Cancer Research found that more than 20% of secondary liver cancers develop from colorectal cancer. Researchers continue to study treatments that can improve survival rates in people with metastatic liver cancer. One promising treatment is the hepatic arterial infusion (HAI) pump.

A hepatic artery infusion pump is a chemotherapy pump for colon cancer and other cancers that have spread to the liver.

Specialists may use a HAI pump to:

  • Control the size and spread of tumors in your liver.
  • Help you live longer and improve your quality of life.
  • Reduce your risk of future liver tumors (recurrence).
  • Shrink liver tumors and make surgery possible.

According to the American Society of Clinical Oncology, studies show improved survival in people with colorectal liver metastases who receive HAI chemotherapy. Researchers continue to study how a hepatic arterial infusion pump can help people with metastatic liver cancer.

What Is Hepatic Arterial Infusion Pump Chemotherapy?

Chemotherapies are drugs that attack and destroy cancer cells. There are multiple ways to get chemotherapy.

Chemotherapy types include:

  • Intra-arterially. A pump puts the chemotherapy drug right into the main artery that supplies blood to part of the body with the tumor.
  • Intravenously. A health care provider inserts a flexible tube (catheter) into a vein. Chemotherapy drugs travel through the veins and into the bloodstream, where they work to destroy cells throughout the body (systemic chemotherapy).
  • Orally. Oncologists prescribe a chemotherapy pill that you take by mouth. You swallow the pill, and the drugs work throughout your body to kill cancer cells.

A HAI pump delivers chemotherapy intra-arterially, directly to the liver through the hepatic artery. This artery is one of two blood vessels that carry blood to the liver.

Surgeons implant the wireless metal pump for HAI under the skin of your abdomen. It’s about 3 inches long. After they implant the HAI pump, surgeons connect it to your hepatic artery with a catheter.

The chemotherapy drug commonly used in HAI therapy is floxuridine. You may also have systemic chemotherapy at the same time to destroy cancer cells outside your liver. With HAI, you may get a lower systemic chemotherapy dose, which can result in fewer chemotherapy side effects.

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How Does Hepatic Arterial Infusion Pump Chemotherapy Work?

An HAI pump typically delivers about 1 milliliter of chemotherapy to your liver every day for two weeks. With HAI, chemotherapy stays inside your liver. Your liver breaks the drug down before it reaches your bloodstream.

When you finish your two-week course, you’ll take a two-week break from chemotherapy. During this break period, the HAI pump will deliver a saline solution containing an anticoagulant (heparin). This will help prevent blood clots from forming.

Benefits of HAI pumps

A hepatic arterial infusion pump offers several benefits. Because it sends chemotherapy drugs directly to your liver, you can get heavier doses of the drugs to the exact tumor location. HAI chemotherapy helps protect healthy tissue and may cause fewer side effects than systemic chemotherapy.

HAI chemotherapy helps:

  • Improve your quality of life when tumors aren’t removable.
  • Kill cancer cells that remain in the liver after tumor removal.

Your surgeon may recommend chemotherapy delivered through a HAI pump when liver tumors are large. Targeting tumors directly with a high dose of chemotherapy can help shrink them. Reducing tumor size may make it possible to remove them with surgery.

How Do Surgeons Implant HAI Pumps?

HAI pump implantation requires surgery.

Surgeons may use:

  • Robotic-assisted surgery. Your surgeon makes small incisions in your abdomen to implant the device. Robot-assisted surgery is less invasive, which may help you heal faster.
  • Traditional (open) surgery. Your surgeon makes a large incision in your abdomen to place the pump and access your hepatic artery.

What happens during HAI pump surgery?

If you have your gallbladder, your surgeon removes it (this is a cholecystectomy). Removing the gallbladder prevents it from getting inflamed as a result of HAI chemotherapy treatment. Sometimes, surgeons remove smaller liver tumors before placing the HAI pump.

Then, your surgeon inserts the HAI pump, typically on the left side of your abdomen. They place the pump in a “pocket” of tissue to help hold it in place. The surgeon then connects the pump to the hepatic artery with a catheter.

After placement, your surgeon may inject a little dye into the pump to test it. The surgeon will then flush the pump and catheter with a low dose of medication to help prevent blood clots.

HAI pump placement surgery usually takes about three hours. You’ll stay in the hospital for a few days after surgery to make sure you’re healing well. Health care providers will also check to make sure you don’t develop any complications with your HAI pump.

Risks of HAI pump surgery

HAI pump placement surgery comes with some risks. As with all surgeries, blood clots and infections are among these risks.

Tell your doctor right away if you have:

  • A fever.
  • Redness.
  • Swelling.

Sometimes, complications develop after surgeons implant the HAI pump.

These complications can include:

  • A change in the pump’s position after implantation.
  • Fluid buildup (seroma) near the HAI pump.
  • Hepatic artery injury.
  • Inflammation of abdominal organs.
  • Pump leakage.

What Happens After HAI Pump Surgery

After surgeons place your HAI pump, you’ll begin chemotherapy treatment. Usually, you won’t feel the pump. Your oncology team will tell you how often you have to go get the pump refilled.

Does a chemotherapy pump for colon cancer cause any side effects?

HAI chemotherapy typically causes fewer side effects than systemic chemotherapy. But you may have some side effects when receiving treatment through a hepatic arterial infusion pump.

Potential side effects include:

  • Damage to the bone marrow (myelosuppression).
  • Diarrhea.
  • Nausea.
  • Vomiting.
  • Swelling of the liver.

Talk to your oncologist about any of the potential side effects of HAI chemotherapy. Your care team can help you prepare for and manage them.

They can also connect you with cancer support resources, including support groups where you can talk with others who are experiencing metastatic liver cancer.

American Cancer Society. Chemotherapy for Liver Cancer. Link

American Cancer Society. Treating Colorectal Cancer. Link

American Society of Clinical Oncology (ASCO). Hepatic Arterial Infusion Pump Chemotherapy: Is It Ready for Prime Time in the United States? Link

Clinical Journal of Oncology Nursing. Use of Hepatic Artery Infusion Pumps in the Treatment of Hepatic Metastases. Link

Journal of Clinical Oncology. Perioperative Hepatic Arterial Infusion Pump Chemotherapy Is Associated with Longer Survival After Resection of Colorectal Liver Metastases: A Propensity Score Analysis. Link

Journal of Surgical Oncology. Hepatic artery infusion pumps. Link

MedlinePlus. Heparin Injection. Link

National Cancer Institute. Hepatic artery. Link

National Cancer Institute. Portal vein. Link

Translational Cancer Research. Incidence and survival outcomes of secondary liver cancer: A Surveillance Epidemiology and End Results database analysis. Link

About UPMC Hillman Cancer Center

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