Perioperative and Oncologic Outcomes of Hepatic Arterial Infusion (HAI) Pump Chemotherapy for Patients with Unresectable Colorectal Liver Metastases at an Expanding HAI Program

Background: Hepatic arterial infusion (HAI) is an established treatment for patients with unresectable colorectal liver metastases (uCRLM). Until recently, HAI was only performed at a limited number of centers. We previously reported early outcomes suggesting that implementation of a new HAI program is safe and feasible. Here, we report perioperative and oncologic outcomes from an expanded series of patients with uCRLM treated with HAI.

Methods: We analyzed outcomes from consecutive patients with uCRLM who underwent HAI pump (HAIP) placement at Duke University Hospital from 2018 to 2023. Demographics, prior treatment, and perioperative and oncologic outcomes were assessed.

Results: Overall, 102 patients underwent HAIP placement for uCRLM; 62% were male and median age was 51 years. Most patients (97%) received a median of 12 (range 0-66) prior chemotherapy cycles. Postoperative HAI-specific complications occurred in 23% of patients, including biliary sclerosis in 6%, and the 90-day mortality rate was 3%. 20% converted to resection, 4% underwent transplant, and 2% achieved complete response at 6 months after floxuridine initiation. Median hepatic and extrahepatic progression-free survival (PFS) was 15.7 months and 11.6 months, respectively. Median overall survival (OS) was 38 months from the time of pump implantation (median follow-up time: 30 months).

Conclusions: HAI for uCRLM is safe, feasible, and effective at a new center, with outcomes that recapitulate those previously reported by established centers. Future analysis of our institutional data, which includes mutation status, primary tumor sidedness, and extent of prior therapy could inform selection and treatment strategies for new HAI programs.