Extrahepatic perfusion and incomplete hepatic perfusion after hepatic arterial infusion pump implantation: incidence and clinical implications

Wills F Filipe; Florian E Buisman; Stijn Franssen; Dutch HAIP consortium; Myrtle F Krul; Dirk J Grünhagen; Roel J Bennink; Karen Bolhuis; Rutger C G Bruijnen; Tineke E Buffart; Mark C Burgmans; Otto M van Delden; Pascal G Doornebosch; Paul D Gobardhan; Laura Graven; Jan Willem B de Groot; Cecile Grootscholten; Jeroen Hagendoorn; Paul Harmsen; Marjolein Y V Homs; Elizabeth G Klompenhouwer; Niels F M Kok; Marnix G E H Lam; Olaf J L Loosveld; Mark A J Meier; J Sven D Mieog; Ad H J Oostdijk; Loubna Outmani; Gijs A Patijn; Stefan Pool; Daphne D D Rietbergen; Jeanine M L Roodhart; Frank M Speetjens; Rutger Jan Swijnenburg; Michelle W J Versleijen; Cornelis Verhoef; Koert F D Kuhlmann; Adriaan Moelker; Bas Groot Koerkamp

doi:10.1016/j.hpb.2024.03.1158

Extrahepatic perfusion and incomplete hepatic perfusion after hepatic arterial infusion pump implantation: incidence and clinical implications

Wills F Filipe^*, Florian E Buisman, Stijn Franssen, Dutch HAIP consortium, Myrtle F Krul, Dirk J Grünhagen, Roel J Bennink, Karen Bolhuis, Rutger C G Bruijnen, Tineke E Buffart, Mark C Burgmans, Otto M van Delden, Pascal G Doornebosch, Paul D Gobardhan, Laura Graven, Jan Willem B de Groot, Cecile Grootscholten, Jeroen Hagendoorn, Paul Harmsen, Marjolein Y V HomsElizabeth G Klompenhouwer, Niels F M Kok, Marnix G E H Lam, Olaf J L Loosveld, Mark A J Meier, J Sven D Mieog, Ad H J Oostdijk, Loubna Outmani, Gijs A Patijn, Stefan Pool, Daphne D D Rietbergen, Jeanine M L Roodhart, Frank M Speetjens, Rutger Jan Swijnenburg, Michelle W J Versleijen, Cornelis Verhoef, Koert F D Kuhlmann, Adriaan Moelker, Bas Groot Koerkamp^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

INTRODUCTION:

This study investigates the incidence of extrahepatic perfusion and incomplete hepatic perfusion at intraoperative methylene blue testing and on postoperative nuclear imaging in patients undergoing hepatic arterial infusion pump (HAIP) chemotherapy.

METHODS:

The first 150 consecutive patients who underwent pump implantation in the Netherlands were included. All patients underwent surgical pump implantation with the catheter in the gastroduodenal artery. All patients underwent intraoperative methylene blue testing and postoperative nuclear imaging ( 99mTc-Macroaggregated albumin SPECT/CT) to determine perfusion via the pump.

RESULTS:

Patients were included between January-2018 and December-2021 across eight centers. During methylene blue testing, 29.3% had extrahepatic perfusion, all successfully managed intraoperatively. On nuclear imaging, no clinically relevant extrahepatic perfusion was detected (0%, 95%CI: 0.0-2.5%). During methylene blue testing, 2.0% had unresolved incomplete hepatic perfusion. On postoperative nuclear imaging, 8.1% had incomplete hepatic perfusion, leading to embolization in only 1.3%.

CONCLUSION:

Methylene blue testing during pump placement for intra-arterial chemotherapy identified extrahepatic perfusion in 29.3% of patients, but could be resolved intraoperatively in all patients. Postoperative nuclear imaging found no clinically relevant extrahepatic perfusion and led to embolization in only 1.3% of patients. The role of routine nuclear imaging after HAIP implantation should be studied in a larger cohort.

Original language	English
Pages (from-to)	919-927
Number of pages	9
Journal	HPB
Volume	26
Issue number	7
Early online date	20 Mar 2024
DOIs	https://doi.org/10.1016/j.hpb.2024.03.1158
Publication status	Published - Jul 2024

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© 2024 The Authors

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Extrahepatic perfusion and incomplete hepatic perfusion after hepatic arterial infusion pump implantationProof, 703 KBLicence: CC BY

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Filipe, W. F., Buisman, F. E., Franssen, S., Dutch HAIP consortium, Krul, M. F., Grünhagen, D. J., Bennink, R. J., Bolhuis, K., Bruijnen, R. C. G., Buffart, T. E., Burgmans, M. C., van Delden, O. M., Doornebosch, P. G., Gobardhan, P. D., Graven, L., de Groot, J. W. B., Grootscholten, C., Hagendoorn, J., Harmsen, P., ... Groot Koerkamp, B. (2024). Extrahepatic perfusion and incomplete hepatic perfusion after hepatic arterial infusion pump implantation: incidence and clinical implications. HPB, 26(7), 919-927. https://doi.org/10.1016/j.hpb.2024.03.1158

@article{15577fedeb4241a4b1056d092da64abd,

title = "Extrahepatic perfusion and incomplete hepatic perfusion after hepatic arterial infusion pump implantation: incidence and clinical implications",

abstract = "INTRODUCTION: This study investigates the incidence of extrahepatic perfusion and incomplete hepatic perfusion at intraoperative methylene blue testing and on postoperative nuclear imaging in patients undergoing hepatic arterial infusion pump (HAIP) chemotherapy.METHODS:The first 150 consecutive patients who underwent pump implantation in the Netherlands were included. All patients underwent surgical pump implantation with the catheter in the gastroduodenal artery. All patients underwent intraoperative methylene blue testing and postoperative nuclear imaging ( 99mTc-Macroaggregated albumin SPECT/CT) to determine perfusion via the pump. RESULTS: Patients were included between January-2018 and December-2021 across eight centers. During methylene blue testing, 29.3% had extrahepatic perfusion, all successfully managed intraoperatively. On nuclear imaging, no clinically relevant extrahepatic perfusion was detected (0%, 95%CI: 0.0-2.5%). During methylene blue testing, 2.0% had unresolved incomplete hepatic perfusion. On postoperative nuclear imaging, 8.1% had incomplete hepatic perfusion, leading to embolization in only 1.3%.CONCLUSION: Methylene blue testing during pump placement for intra-arterial chemotherapy identified extrahepatic perfusion in 29.3% of patients, but could be resolved intraoperatively in all patients. Postoperative nuclear imaging found no clinically relevant extrahepatic perfusion and led to embolization in only 1.3% of patients. The role of routine nuclear imaging after HAIP implantation should be studied in a larger cohort.",

author = "Filipe, {Wills F} and Buisman, {Florian E} and Stijn Franssen and {Dutch HAIP consortium} and Krul, {Myrtle F} and Gr{\"u}nhagen, {Dirk J} and Bennink, {Roel J} and Karen Bolhuis and Bruijnen, {Rutger C G} and Buffart, {Tineke E} and Burgmans, {Mark C} and {van Delden}, {Otto M} and Doornebosch, {Pascal G} and Gobardhan, {Paul D} and Laura Graven and {de Groot}, {Jan Willem B} and Cecile Grootscholten and Jeroen Hagendoorn and Paul Harmsen and Homs, {Marjolein Y V} and Klompenhouwer, {Elizabeth G} and Kok, {Niels F M} and Lam, {Marnix G E H} and Loosveld, {Olaf J L} and Meier, {Mark A J} and Mieog, {J Sven D} and Oostdijk, {Ad H J} and Loubna Outmani and Patijn, {Gijs A} and Stefan Pool and Rietbergen, {Daphne D D} and Roodhart, {Jeanine M L} and Speetjens, {Frank M} and Swijnenburg, {Rutger Jan} and Versleijen, {Michelle W J} and Cornelis Verhoef and Kuhlmann, {Koert F D} and Adriaan Moelker and {Groot Koerkamp}, Bas",

note = "Publisher Copyright: {\textcopyright} 2024 The Authors",

year = "2024",

month = jul,

doi = "10.1016/j.hpb.2024.03.1158",

language = "English",

volume = "26",

pages = "919--927",

journal = "HPB",

issn = "1365-182X",

publisher = "Elsevier",

number = "7",

}

Filipe, WF , Buisman, FE , Franssen, S, Dutch HAIP consortium, Krul, MF, Grünhagen, DJ, Bennink, RJ, Bolhuis, K, Bruijnen, RCG, Buffart, TE, Burgmans, MC, van Delden, OM, Doornebosch, PG, Gobardhan, PD, Graven, L, de Groot, JWB, Grootscholten, C, Hagendoorn, J, Harmsen, P, Homs, MYV, Klompenhouwer, EG, Kok, NFM, Lam, MGEH, Loosveld, OJL, Meier, MAJ, Mieog, JSD, Oostdijk, AHJ, Outmani, L, Patijn, GA, Pool, S, Rietbergen, DDD, Roodhart, JML, Speetjens, FM, Swijnenburg, RJ, Versleijen, MWJ, Verhoef, C, Kuhlmann, KFD, Moelker, A & Groot Koerkamp, B 2024, 'Extrahepatic perfusion and incomplete hepatic perfusion after hepatic arterial infusion pump implantation: incidence and clinical implications', HPB, vol. 26, no. 7, pp. 919-927. https://doi.org/10.1016/j.hpb.2024.03.1158

TY - JOUR

T1 - Extrahepatic perfusion and incomplete hepatic perfusion after hepatic arterial infusion pump implantation

T2 - incidence and clinical implications

AU - Filipe, Wills F

AU - Buisman, Florian E

AU - Franssen, Stijn

AU - Dutch HAIP consortium

AU - Krul, Myrtle F

AU - Grünhagen, Dirk J

AU - Bennink, Roel J

AU - Bolhuis, Karen

AU - Bruijnen, Rutger C G

AU - Buffart, Tineke E

AU - Burgmans, Mark C

AU - van Delden, Otto M

AU - Doornebosch, Pascal G

AU - Gobardhan, Paul D

AU - Graven, Laura

AU - de Groot, Jan Willem B

AU - Grootscholten, Cecile

AU - Hagendoorn, Jeroen

AU - Harmsen, Paul

AU - Homs, Marjolein Y V

AU - Klompenhouwer, Elizabeth G

AU - Kok, Niels F M

AU - Lam, Marnix G E H

AU - Loosveld, Olaf J L

AU - Meier, Mark A J

AU - Mieog, J Sven D

AU - Oostdijk, Ad H J

AU - Outmani, Loubna

AU - Patijn, Gijs A

AU - Pool, Stefan

AU - Rietbergen, Daphne D D

AU - Roodhart, Jeanine M L

AU - Speetjens, Frank M

AU - Swijnenburg, Rutger Jan

AU - Versleijen, Michelle W J

AU - Verhoef, Cornelis

AU - Kuhlmann, Koert F D

AU - Moelker, Adriaan

AU - Groot Koerkamp, Bas

PY - 2024/7

Y1 - 2024/7

N2 - INTRODUCTION: This study investigates the incidence of extrahepatic perfusion and incomplete hepatic perfusion at intraoperative methylene blue testing and on postoperative nuclear imaging in patients undergoing hepatic arterial infusion pump (HAIP) chemotherapy.METHODS:The first 150 consecutive patients who underwent pump implantation in the Netherlands were included. All patients underwent surgical pump implantation with the catheter in the gastroduodenal artery. All patients underwent intraoperative methylene blue testing and postoperative nuclear imaging ( 99mTc-Macroaggregated albumin SPECT/CT) to determine perfusion via the pump. RESULTS: Patients were included between January-2018 and December-2021 across eight centers. During methylene blue testing, 29.3% had extrahepatic perfusion, all successfully managed intraoperatively. On nuclear imaging, no clinically relevant extrahepatic perfusion was detected (0%, 95%CI: 0.0-2.5%). During methylene blue testing, 2.0% had unresolved incomplete hepatic perfusion. On postoperative nuclear imaging, 8.1% had incomplete hepatic perfusion, leading to embolization in only 1.3%.CONCLUSION: Methylene blue testing during pump placement for intra-arterial chemotherapy identified extrahepatic perfusion in 29.3% of patients, but could be resolved intraoperatively in all patients. Postoperative nuclear imaging found no clinically relevant extrahepatic perfusion and led to embolization in only 1.3% of patients. The role of routine nuclear imaging after HAIP implantation should be studied in a larger cohort.

AB - INTRODUCTION: This study investigates the incidence of extrahepatic perfusion and incomplete hepatic perfusion at intraoperative methylene blue testing and on postoperative nuclear imaging in patients undergoing hepatic arterial infusion pump (HAIP) chemotherapy.METHODS:The first 150 consecutive patients who underwent pump implantation in the Netherlands were included. All patients underwent surgical pump implantation with the catheter in the gastroduodenal artery. All patients underwent intraoperative methylene blue testing and postoperative nuclear imaging ( 99mTc-Macroaggregated albumin SPECT/CT) to determine perfusion via the pump. RESULTS: Patients were included between January-2018 and December-2021 across eight centers. During methylene blue testing, 29.3% had extrahepatic perfusion, all successfully managed intraoperatively. On nuclear imaging, no clinically relevant extrahepatic perfusion was detected (0%, 95%CI: 0.0-2.5%). During methylene blue testing, 2.0% had unresolved incomplete hepatic perfusion. On postoperative nuclear imaging, 8.1% had incomplete hepatic perfusion, leading to embolization in only 1.3%.CONCLUSION: Methylene blue testing during pump placement for intra-arterial chemotherapy identified extrahepatic perfusion in 29.3% of patients, but could be resolved intraoperatively in all patients. Postoperative nuclear imaging found no clinically relevant extrahepatic perfusion and led to embolization in only 1.3% of patients. The role of routine nuclear imaging after HAIP implantation should be studied in a larger cohort.

UR - http://www.scopus.com/inward/record.url?scp=85190140207&partnerID=8YFLogxK

U2 - 10.1016/j.hpb.2024.03.1158

DO - 10.1016/j.hpb.2024.03.1158

M3 - Article

C2 - 38604828

SN - 1365-182X

VL - 26

SP - 919

EP - 927

JO - HPB

JF - HPB

IS - 7

ER -

Extrahepatic perfusion and incomplete hepatic perfusion after hepatic arterial infusion pump implantation: incidence and clinical implications

Abstract

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