Technical complications and durability of hepatic artery infusion pumps for unresectable colorectal liver metastases: An institutional experience of 544 consecutive cases
Technical complications and durability of hepatic artery infusion pumps for unresectable colorectal liver metastases: An institutional experience of 544 consecutive cases
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DOI：
10.1016/j.jamcollsurg.2005.03.019
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发表时间：
2005-07-01
影响因子：
5.2
通讯作者：
Paty, PB
中科院分区：
文献类型：
--
作者：
Allen, PJ;Nissan, A;Paty, PB
背景：肝动脉灌注泵化疗是治疗肝转移瘤的重要组成部分。成功使用肝动脉灌注泵需要较低的技术并发症发生率。我们在我们的机构评估了这些设备的并发症和长期耐用性。研究设计：1986年4月至2001年3月期间，544名患者接受了肝动脉输液泵放置以治疗不可切除的结直肠肝转移瘤。通过病历审查收集患者和泵相关数据。记录泵相关并发症、泵功能持续时间和患者总生存率。结果：泵植入后患者中位生存期为24个月。1年时泵故障的发生率为9%，2年时为16%。120例（22%）患者发生泵并发症。术后早期（< 30天）发生的并发症较晚期发生的并发症更容易挽救（70%比30%，P <0.001）。在不同动脉解剖结构的情况下，泵并发症发生率增加（28% vs 19%，p = 0.02），当导管插入胃十二指肠动脉以外的血管时（42% vs 21%，p = 0.004），如果在研究期的前半部分放置泵（1986年至1993年，25%对比1994年至2001年，18%; P = 0.05），如果外科医生进行的早期手术少于25例，（< 25，31%对比>= 2：25，19%; p < 0.002）。在这一大型单一机构的经验中，泵相关并发症较低，大多数早期泵并发症得到挽救，泵并发症发生率随着机构经验的积累而改善。泵功能的长期耐久性极佳。(c)2005年，美国外科医生学会。
BACKGROUND: Hepatic arterial infusion pump chemotherapy is an important component in the treatment of patients with hepatic metastases. Successful use of a hepatic arterial infusion pump requires a low technical complication rate. We evaluated the complications and longterm durability of these devices at our institution.STUDY DESIGN: Between April 1986 and March 2001, 544 patients underwent hepatic arterial infusion pump placement for treatment of unresectable colorectal liver metastases. Patient-and pump-related data were collected by chart review. Pump-related complications, duration of pump function, and overall patient survival were recorded.RESULTS: Median patient survival was 24 months after pump placement. The incidences of pump failure were 9% at 1 year and 16% at 2 years. Pump complications occurred in 120 (22%) of the patients. Complications that occurred early after operation (< 30 days) were more likely to be salvaged than those occurring late (70% versus 30%, p < 0.00 1). Increased pump complication rates occurred in the setting of variant arterial anatomy (28% versus 19%, p = 0.02), when the catheter was inserted into a vessel other than the gastroduodenal artery (42% versus 21%, p = 0.004), if the pump was placed during the first half of the study period (1986 to 1993, 25% versus 1994 to 2001, 18%; P = 0.05), and if the surgeon had performed fewer than 25 earlier procedures (< 25, 31% versus >= 2 : 25, 19%; p < 0.002).CONCLUSIONS: In this large single institution experience, pump-related complications were low, the majority of early pump complications were salvaged, and pump complication rates improved as institutional experience accumulated. Longterm durability of pump function was excellent. (c) 2005 by the American College of Surgeons.