Management of hepatic arterial infusion port following prophylactic regional chemotherapy in patients who have undergone curative resection of colorectal liver metastases

Purpose. Although hepatic arterial infusion (HAI) is widely performed as a prophylactic chemotherapy for patients who have undergone a curative resection of a metastatic liver tumor from colorectal cancer, the optimal management of implantable ports and catheters after the cessation of such adjuvant therapy remains to be elucidated. Methods. The survival and recurrence rate of 30 patients who received adjuvant regional chemotherapy following a hepatectomy were examined. The outcomes of the 15 patients who were regularly administered heparin into the port to prevent its occlusion were also analyzed. Results. With a median follow-up period of 38.1 months, local recurrence in the residual liver was observed in only 5 patients (17%), and the 3-year hepatic disease-free survival was as high as 82%. Out of the 15 patients who received heparin injection, the ports were successfully maintained in only 6 patients (40%) at from 8.8 to 24.7 months (median, 10.8 months) postoperatively, and 69% of the implantable ports were maintained without occlusion for 12 months. Furthermore, a second course of regional chemotherapy was carried out in only one patient, while a repeat hepatectomy was performed instead of chemotherapy in the other patients with hepatic recurrence. Conclusions. Because HAI remarkably reduced the degree of relapse in the residual liver, there is no benefit in maintaining the port after discontinuing the chemotherapy. Heparin administration via the same port after a cessation of the prophylactic HAI chemotherapy is not justified, and it is desirable to remove the implanted catheter when possible.