Hepatic Artery Infusion Pump Chemotherapy: Procedure, Benefits, Risks, Recovery and Alternatives

Hepatic artery infusion pump (HAIP) chemotherapy is a specialized treatment that delivers high concentrations of chemotherapy directly to the liver, often used for cancers that have spread to or originated in the liver. This approach has become increasingly important in the management of liver tumors, especially when systemic therapies are insufficient or when the disease is confined to the liver. In this article, we’ll explore how HAIP chemotherapy works, its benefits, potential risks, the recovery process, and alternatives available to patients.

Hepatic Artery Infusion Pump Chemotherapy: The Procedure

Hepatic artery infusion pump chemotherapy is an advanced, patient-centered technique designed to maximize the impact of treatment on liver tumors while minimizing systemic side effects. The procedure involves the surgical implantation of a small, refillable pump that delivers chemotherapy directly into the hepatic artery—the main vessel supplying blood to liver tumors. By targeting the tumor’s blood supply, HAIP chemotherapy increases drug concentrations in the cancerous tissue, potentially improving outcomes for patients with liver-dominant disease.

Step	Description	Purpose/Outcome	Source(s)
Implantation	Surgical placement of pump and catheter	Enables direct drug delivery	1 3 5 14
Infusion	Pump administers chemo to hepatic artery	Higher local drug concentration	1 6 8 18
Refills	Percutaneous injection to refill the pump	Continues therapy over months	1 5 14
Outpatient	Most care and monitoring are ambulatory	Minimizes hospital stays	1 14 16

Table 1: Overview of HAIP Chemotherapy Procedure Steps

Surgical Placement and Setup

The procedure begins with surgical implantation of a small infusion pump, typically in the abdomen or chest wall, and attachment of a catheter that leads directly into the hepatic artery. This can be done via open surgery (laparotomy) or less invasive approaches, such as angiographically guided catheterization, which avoids the need for a large surgical incision and may reduce recovery time and risk of complications 1 3 5 14.

How the Pump Works

The pump is designed to deliver a continuous, controlled dose of chemotherapy—most often floxuridine (FUDR)—directly to liver tumors. The pump is refillable via a simple percutaneous (through the skin) injection, allowing for ongoing treatment without repeated surgeries. Refills are typically done weekly or at regular intervals 1 5 14.

Outpatient Management

After initial implantation and setup, most of the patient’s care is managed on an outpatient basis. This supports patient comfort and convenience, reduces hospital stays, and allows for long-term therapy as needed 1 14 16. Some pumps are designed to last for months or even years, depending on treatment needs and device durability.

Benefits and Effectiveness of Hepatic Artery Infusion Pump Chemotherapy

HAIP chemotherapy offers several unique advantages over systemic chemotherapy, particularly for patients with liver-only or liver-dominant tumors. By delivering chemotherapy directly to the liver, this method can achieve much higher local drug concentrations, potentially leading to better tumor response rates.

Benefit	Outcome/Statistic	Patient Group/Setting	Source(s)
Higher Response	Up to 92% response in chemo-naive cases	Unresectable colorectal liver metastasis	8
Improved Survival	Median survival 17–67 months	Colorectal liver metastases (CRLM)	6 7 9
Disease Control	97% control rate in advanced HCC	HCC (with combination therapies)	12 13
Augmented Resectability	Up to 52% conversion to surgery	Initially unresectable metastases	8

Table 2: Key Benefits and Effectiveness Outcomes of HAIP Chemotherapy

Localized High-Dose Delivery

Delivering chemotherapy via the hepatic artery allows for much higher concentrations of drugs such as floxuridine and mitomycin C in the tumor (up to 100 times higher for floxuridine) while minimizing systemic exposure and related toxicities 1 18. This is particularly valuable for liver metastases from colorectal cancer and certain primary liver cancers.

Tumor Response and Survival Rates

• Colorectal Liver Metastases (CRLM): HAIP chemotherapy, especially when combined with surgery, improves disease-free and overall survival. Studies show a median survival of 17–67 months and 10-year survival rates up to 61% in selected patients 3 6 7 9.
• Unresectable Disease: In patients with liver-predominant disease not amenable to surgery, HAIP can still yield meaningful responses, with up to 92% response rates in chemo-naive patients and 85% in those previously treated with systemic chemotherapy 8.
• Hepatocellular Carcinoma (HCC): When combined with systemic agents or immunotherapy, HAIP can result in high disease control rates (up to 97%) and promising progression-free survival rates in advanced cases 12 13 17.

Augmenting Resectability

One of the most compelling uses of HAIP is to shrink previously unresectable tumors, enabling surgical removal. Conversion-to-resection rates reach as high as 52% in heavily pretreated patients, offering the possibility of long-term remission or cure 8.

Risks and Side Effects of Hepatic Artery Infusion Pump Chemotherapy

While HAIP offers significant benefits, it is not without risks. The procedure and therapy can cause both general and specific complications, some of which may be serious and require prompt intervention.

Risk/Side Effect	Frequency/Severity	Notes/Management	Source(s)
Biliary Sclerosis	2–18%	Salvageable with stenting	10 11
Hepatitis	Up to 49% (resolves after stopping)	More common in responders	6
Peptic Ulcers	~18%	Heals after chemo stopped	6 11
Pump Complications	9–22% (failure, malfunction, infection)	Most managed with intervention	3 11 14

Table 3: Major Risks and Side Effects Associated with HAIP Chemotherapy

Procedure-Related Complications

• Pump and Catheter Issues: Early and late complications can include pump malfunction, catheter dislodgement, or infection. Most are manageable, but some require reoperation or device replacement 3 14.
• Vascular Events: Risks such as bleeding, thrombosis, or extrahepatic perfusion are rare with experienced surgical teams 3 14.

Chemotherapy-Related Toxicities

• Biliary Sclerosis: A potentially serious complication involving scarring and narrowing of the bile ducts. Incidence ranges from 2% to 18%, more common in adjuvant use after surgery, but rarely fatal and often manageable with stenting 10 11.
• Hepatitis: Temporary liver inflammation occurs in up to 49% of patients, more frequently among those with strong tumor responses. Usually reversible after pausing therapy 6.
• Gastrointestinal Issues: Peptic ulceration can develop in up to 18% of patients, resolving after discontinuation of HAIP chemotherapy 6 11.
• Other Adverse Effects: Systemic side effects (e.g., bone marrow suppression, infection) are less common due to the regional nature of the therapy, but can occur, especially in combination regimens 12 13 17.

Comparative Morbidity

While HAIP can increase the frequency of liver-specific or device-related complications, studies show that with careful patient selection, experienced teams, and close monitoring, most risks are manageable and do not significantly compromise overall survival 3 10 11 14 16.

Recovery and Aftercare of Hepatic Artery Infusion Pump Chemotherapy

Recovery from HAIP chemotherapy involves both immediate post-surgical care and ongoing management to ensure patient safety and therapeutic effectiveness. The aftercare process is designed to support patients’ quality of life and minimize complications.

Aspect	Typical Experience/Timeline	Notes	Source(s)
Post-op Recovery	1–2 weeks for surgical healing	Outpatient management preferred	3 5 14 16
Pump Refills	Weekly or regular intervals	Performed percutaneously	1 5 14
Monitoring	Imaging, blood tests, flow scans	Early detection of complications	3 10 14
Quality of Life	Temporary decline, then recovery	Most patients resume activities	12 13

Table 4: Recovery and Aftercare Process for HAIP Chemotherapy

Immediate Postoperative Recovery

• Hospital Stay: Most patients require a short hospital stay after pump implantation, with recovery times varying depending on whether the surgery was open or minimally invasive 3 5 14.
• Wound Care: Incision sites must be monitored for signs of infection or hematoma, but major surgical complications are relatively rare with experienced teams 3 5 14.
• Pain Management: Discomfort is usually manageable with standard pain control methods.

Ongoing Treatment and Monitoring

• Pump Refills: The pump is refilled on a regular schedule (often weekly), which can be done in an outpatient clinic via a simple percutaneous procedure 1 5 14.
• Surveillance: Routine follow-up includes imaging (e.g., CT scans), blood tests (including liver function and tumor markers), and flow scans to ensure the integrity of the pump-catheter system and early detection of complications like biliary sclerosis or liver toxicity 3 10 14.

Managing Side Effects and Complications

• Early Intervention: Prompt identification and management of side effects (e.g., stopping therapy for hepatitis or treating biliary strictures with stents) are key to maintaining patient safety 6 10 14.
• Quality of Life: Some patients experience a transient decline in quality of life, particularly during the initial cycles of treatment, but most recover and can resume daily activities 12 13.

Alternatives of Hepatic Artery Infusion Pump Chemotherapy

Not every patient is a candidate for HAIP chemotherapy, and several alternative therapies exist for liver tumors. Choice of treatment depends on tumor type, extent of disease, patient health, and previous therapies.

Alternative	Indication/Setting	Key Points	Source(s)
Systemic Chemotherapy	Widespread or extrahepatic disease	Standard for many cancers	2 7 16 18
Surgical Resection	Resectable disease, good liver reserve	Potentially curative	3 4 7 9
Ablation/RFA	Small, localized tumors	Minimally invasive	3 9 16
TACE	Unresectable HCC, not for all cases	Localized chemoembolization	17 18
Immunotherapy/combo	Advanced HCC	Combos with HAIP, promising	12 13

Table 5: Key Alternatives to HAIP Chemotherapy

Systemic Chemotherapy

• Description: Intravenous or oral chemotherapy delivered throughout the body.
• Role: Mainstay for metastatic cancers with extrahepatic spread or when HAIP is not feasible. Newer regimens and targeted agents have improved outcomes, but response rates and survival are often lower compared to liver-directed therapies in selected patients 2 7 16 18.

Surgical Resection

• Description: Surgical removal of liver tumors.
• Role: The gold standard for potentially curative treatment in patients with resectable disease and adequate liver function. Long-term survival is possible, but only a minority of patients are eligible 3 4 7 9.

Ablation and Radiofrequency Ablation (RFA)

• Description: Image-guided destruction of tumors using heat or other energy sources.
• Role: Useful for small, localized tumors, especially when surgery is not possible 3 9 16.

Transarterial Chemoembolization (TACE)

• Description: Delivers chemotherapy and embolic agents directly into liver tumors via the hepatic artery.
• Role: Standard for unresectable hepatocellular carcinoma (HCC), but not suitable for all patients. HAIP can be considered when TACE fails or is unsuitable 17 18.

Immunotherapy and Combination Approaches

• Description: Immune checkpoint inhibitors and targeted therapies, often in combination with HAIP or systemic chemotherapy.
• Role: Emerging evidence supports their use in advanced HCC and other liver tumors, with promising response rates and manageable toxicity 12 13.

Conclusion

Hepatic artery infusion pump chemotherapy is a sophisticated and promising approach for selected patients with liver-dominant cancers. By delivering high-dose chemotherapy directly to the liver, it maximizes tumor control while limiting systemic side effects. However, it does carry specific risks and requires specialized care.

Key takeaways:

• HAIP delivers chemotherapy directly to liver tumors, allowing higher local concentrations with fewer systemic effects 1 6 8 18.
• The procedure involves surgical pump implantation, regular outpatient refills, and close monitoring 1 3 5 14.
• Benefits include improved tumor response rates, prolonged survival, and increased chances of surgical resection in select cases 6 7 8 9 12 13.
• Risks include device-related complications, biliary sclerosis, hepatitis, and gastrointestinal issues, but most are manageable with experienced care 6 10 11 14.
• Recovery is usually rapid, with most patients resuming normal activities and ongoing outpatient management 3 5 14 16.
• Alternatives such as systemic chemotherapy, surgery, ablation, TACE, and immunotherapy are available and may be more appropriate in some cases 2 3 4 7 12 13 16 17 18.

Patients considering HAIP chemotherapy should consult a multidisciplinary team at an experienced center to discuss the best individualized treatment plan for their specific situation.