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Short-Term Risk of Performing Concurrent Procedures with Hepatic Artery Infusion Pump Placement

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Hepatic artery infusion pump (HAIP) chemotherapy is an advanced cancer therapy for primary and secondary hepatic malignancies. The risk of concurrent hepatic and/or colorectal operations with HAIP placement is unknown. Our objective was to characterize the short-term outcomes of concurrent surgery with HAIP placement.

Methods

The 2005–2017 ACS NSQIP dataset was queried for patients undergoing hepatic and colorectal operations with or without HAIP placement. Outcomes were compared for HAIP placement with different combined procedures. Patients who underwent procedures without HAIP placement were propensity score matched with those with HAIP placement. The primary outcome was 30-day death or serious morbidity (DSM). Secondary outcomes included infectious complications, wound complications, length of stay (LOS), and operative time.

Results

Of 467 patients who underwent HAIP placement, 83.9% had concurrent surgery. The rate of DSM was 10.7% for HAIP placement alone, 19.2% with concurrent minor hepatic procedures, 22.1% with concurrent colorectal resection, 23.2% with concurrent minor hepatic plus colorectal procedures, 28.4% with concurrent major hepatic resection, and 41.7% with concurrent major hepatic plus colorectal resection. On matched analyses, there was no difference in DSM, infectious, or wound complications for procedures with HAIP placement compared with the additional procedure alone, but operative time (294.7 vs 239.8 min, difference 54.9, 95% CI 42.8–67.0) and LOS (6 vs 5, IRR 1.20, 95% CI 1.08–1.33) were increased.

Conclusions

HAIP placement is not associated with additional morbidity when performed with hepatic and/or colorectal surgery. Decisions regarding HAIP placement should consider the risks of concurrent operations, and patient- and disease-specific factors.

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Acknowledgments

DJB is supported by the Veteran’s Administration (I01HX002290). ADY is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health (K08HL145139). RPM is supported by the Agency for Healthcare Research and Quality (K12HS026385) and an Institutional Research Grant from the American Cancer Society (IRG-18-163-24). DM provides advising or speaking services for Amgen Inc., Bristol Meyers Squibb Company, Exelixis Inc., Eisai Co. Ltd., and Genentech Inc. and receives research funding from Merck & Co. Inc. and Oncolytics Biotech Inc.

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Authors and Affiliations

  1. Department of Surgery, Feinberg School of Medicine, Surgical Outcomes and Quality Improvement Center, Northwestern University, Chicago, IL, USA

    Brian C. Brajcich MD, David J. Bentrem MD, MS, Anthony D. Yang MD, MS, Ryan J. Ellis MD, MS & Ryan P. Merkow MD, MS

  2. American College of Surgeons, Chicago, IL, USA

    Brian C. Brajcich MD, Mark E. Cohen PhD, Ryan J. Ellis MD, MS & Ryan P. Merkow MD, MS

  3. Department of Surgery, Jesse Brown Veterans’ Affairs Medical Center, Chicago, IL, USA

    David J. Bentrem MD, MS

  4. Department of Medicine, Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Devalingam Mahalingam MBBChBAO, PhD & Mary F. Mulcahy MD

  5. Department of Surgery, Duke University School of Medicine, Durham, NC, USA

    Michael E. Lidsky MD & Peter J. Allen MD

Authors
  1. Brian C. Brajcich MD
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  2. David J. Bentrem MD, MS
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  3. Anthony D. Yang MD, MS
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  4. Mark E. Cohen PhD
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  5. Ryan J. Ellis MD, MS
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  9. Peter J. Allen MD
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  10. Ryan P. Merkow MD, MS
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Corresponding author

Correspondence to Ryan P. Merkow MD, MS.

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Disclosure

DM provides advising or speaking services for Amgen Inc., Bristol Meyers Squibb Company, Exelixis Inc., Eisai Co. Ltd., and Genentech Inc. and receives research funding from Merck & Co. Inc. and Oncolytics Biotech Inc.

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Appendix 1: Current procedure terminology (CPT) codes included in each cohort

Appendix 1: Current procedure terminology (CPT) codes included in each cohort

Operative cohort

CPT codes

Hepatic artery infusion pump placement

36260

Colon or rectum resection

44120, 44140, 44141, 44143, 44144, 44145, 44146, 44147, 44150, 44151, 44155, 44156, 44157, 44158, 44160, 44204, 44205, 44206, 44207, 44208, 44210, 44211, 44212, 45110, 45111, 45112, 45113, 45114, 45116, 45119, 45120, 45121, 45123, 45126, 45130, 45135, 45160, 45395, 45397, 45402, 45550

Major hepatic resection

47122, 47125, 47130

Minor hepatic procedures

47100, 47120, 47370, 47371, 47379, 47380, 47381, 47382, 47383, 47399

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Brajcich, B.C., Bentrem, D.J., Yang, A.D. et al. Short-Term Risk of Performing Concurrent Procedures with Hepatic Artery Infusion Pump Placement. Ann Surg Oncol 27, 5098–5106 (2020). https://doi.org/10.1245/s10434-020-08938-0

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