295 Background: Previously treated Hepatic Colorectal Metastases (CRC) and advanced hepato cellular cancer (HCC) are tumor challenges frequently unresponsive to systemic chemo therapy (CT). We reviewed survival outcome in chemo resistant / high risk patients following hepatic artery infusion (HAI) in 21 CRC pts, 10 HCC pts, and 6 miscellaneous metastatic cancers. Methods: Patient groups: 21 CRC pts (16M, 5 F), mean age 63: 16 had metachronous (DFI-17 mos), and 5 Synchronous CA; liver extent: 76% multiple (>5) mets or extensive bilateral; CEA (ng/m), >100, 8 pts > 50 (3 pts) ;< 5 (3 pts),UNK(7 pts). Previous CT:FU/LV (11pts), Oxaliplatin (OX) or Irinotecan (IR) (10 pts). Liver surgery: Partial Resection/RFA – 9 pts. HCC – (9 PTS), cholangioCA(1pt); M/F 5/5; av.age 63yr.. Previous RX Hepatic lobectomy 4 pts, RFA/TACE – 3 patients. Miscellaneous GP (therapy): Hepatic lobectomy + HAI were in metastatic lung (1), Breast (1), advanced gall bladder Ca (GBCA) (T 3-4) (2 pts); HAI alone was done in Br. CA (1) carcinoid (1) Treatment Protocols: CRC: HAI-FUDR 12/15mg/kg/d, dexamethasone 2mg.kg/d, leukovorin (20mg/M2/d) X14 d plus bolus (d1), oxaliplatin OX 130 mg/M2 cisplatin CIS, 100 mg/M2; Systemic RX: d20-30. OX I.V. 130mg/M2, capecitabine 750-1,000 mg/M2/d x 10 days (also used in Miscel. Grp.) HCC Protocol: HAI-14 d as in CRC Protocol. Bolus infusion d1-doxorubicin 75mg/M2or OX or CIS as in CRC schema. Results: CRC:OS-CRC post start HAI = med/16 mos., 2yr/5yr = 27%/6%. HCC OS = 9 mos.( Median); 3->41mos in 9 evaluable pts.; 1 HCC pt with recurrence 2 yr. post hepatectomy survived over 3.5 yrs. with HAI + RFA/TACE – (OS-67mo).Miscellaneous group included lung (11 mos) Br CA (23, 9 mos) adv. Carcinoid (3 mos), GBCA (2 pts > 60 mos), Major Complications; Pump malfunction (4 pts), misperfusion (2) pts, infected pocket (2) pt, duodenal fistula (1) pt. Conclusions: Hepatic artery infusion alternating with systemic chemo therapy has apparent survival benefit in selected patients with persistent or progressive chemo resistant malignancy from metastatic CRC, HCC, or selected miscellaneous cancers (breast, lung, liver, gall bladder cancer) and warrants further study.
Robotic Choledocal Cyst Resection and Hepaticojejunostomy at a Case with Aberrant Hepatic Artery Sailing on the Gall Bladder
