Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2024

Open Access 18-03-2024 | Cholangiocarcinoma | Hepatobiliary Tumors

Robotic Versus Open Hepatic Arterial Infusion Pump Placement for Unresectable Intrahepatic Cholangiocarcinoma

Authors: Britte H. E. A. Ten Haaft, MD, Stijn Franssen, MD, Roderick W. J. J. van Dorst, BSc, Merve Rousian, MD, Gabriela Pilz da Cunha, MD, Roeland F. de Wilde, MD, PhD, Joris I. Erdmann, MD, PhD, Bas Groot Koerkamp, MD, PhD, Jeroen Hagendoorn, MD, PhD, Rutger-Jan Swijnenburg, MD, PhD

Published in: Annals of Surgical Oncology | Issue 6/2024

Login to get access

Abstract

Background

Hepatic arterial infusion pump (HAIP) chemotherapy is an effective treatment for patients with unresectable intrahepatic cholangiocarcinoma (iCCA). HAIP chemotherapy requires a catheter inserted in the gastroduodenal artery and a subcutaneous pump. The catheter can be placed using an open or robotic approach.

Objective

This study aimed to compare perioperative outcomes of robotic versus open HAIP placement in patients with unresectable iCCA.

Methods

We analyzed patients with unresectable iCCA included in the PUMP-II trial from January 2020 to September 2022 undergoing robotic or open HAIP placement at Amsterdam UMC, Erasmus MC, and UMC Utrecht. The primary outcome was time to functional recovery (TTFR).

Results

In total, 22 robotic and 28 open HAIP placements were performed. The median TTFR was 2 days after robotic placement versus 5 days after open HAIP placement (p < 0.001). One patient (4.5%) in the robotic group underwent a conversion to open because of a large bulky tumor leaning on the hilum immobilizing the liver. Postoperative complications were similar—36% (8/22) after robotic placement versus 39% (11/28) after open placement (p = 1.000). The median length of hospital stay was shorter in the robotic group—3 versus 5 days (p < 0.001). All 22 robotic patients initiated HAIP chemotherapy post-surgery, i.e. 93% (26/28) in the open group (p = 0.497). The median time to start HAIP chemotherapy was 14 versus 18 days (p = 0.153).

Conclusion

Robotic HAIP placement in patients with unresectable iCCA is a safe and effective procedure and is associated with a significantly shorter TTFR and hospital stay than open HAIP placement.
Appendix
Available only for authorised users
Literature
1.
Khan SA, Tavolari S, Brandi G. Cholangiocarcinoma: epidemiology and risk factors. Liver Int. 2019;39(Suppl 1):19–31.CrossRefPubMed
2.
3.
Endo I, et al. Intrahepatic cholangiocarcinoma: rising frequency, improved survival, and determinants of outcome after resection. Ann Surg. 2008;248(1):84–96.CrossRefPubMed
4.
Lamarca A, et al. Advanced intrahepatic cholangiocarcinoma: post-hoc analysis of the ABC-01, -02 and -03 clinical trials. J Natl Cancer Inst. 2020;112(2):200–10.PubMed
5.
Oh D-Y, et al. Durvalumab plus gemcitabine and cisplatin in advanced biliary tract cancer. NEJM Evidence. 2022;1(8):EVIDoa200015.CrossRef
6.
Ackerman NB. The blood supply of experimental liver metastases. IV. Changes in vascularity with increasing tumor growth. Surgery. 1974;75(4):589–96.PubMed
7.
8.
Ensminger WD, Gyves JW. Clinical pharmacology of hepatic arterial chemotherapy. Semin Oncol. 1983;10(2):176–82.PubMed
9.
Dizon DS, Schwartz J, Kemeny N. Regional chemotherapy: a focus on hepatic artery infusion for colorectal cancer liver metastases. Surg Oncol Clin N Am. 2008;17(4):759–71.CrossRefPubMed
10.
Cercek A, et al. Assessment of hepatic arterial infusion of floxuridine in combination with systemic gemcitabine and oxaliplatin in patients with unresectable intrahepatic cholangiocarcinoma: a phase 2 clinical trial. JAMA Oncol. 2020;6(1):60–7.CrossRefPubMed
11.
Kemeny NE, et al. Treating primary liver cancer with hepatic arterial infusion of floxuridine and dexamethasone: does the addition of systemic bevacizumab improve results? Oncology. 2011;80(3–4):153–9.CrossRefPubMedPubMedCentral
12.
Jarnagin WR, et al. Regional chemotherapy for unresectable primary liver cancer: results of a phase II clinical trial and assessment of DCE-MRI as a biomarker of survival. Ann Oncol. 2009;20(9):1589–95.CrossRefPubMedPubMedCentral
13.
14.
Dhir M, et al. Robotic assisted placement of hepatic artery infusion pump is a safe and feasible approach. J Surg Oncol. 2016;114(3):342–7.CrossRefPubMed
15.
16.
de Rooij T, et al. Minimally invasive versus open distal pancreatectomy (LEOPARD): a multicenter patient-blinded randomized controlled trial. Ann Surg. 2019;269(1):2–9.CrossRefPubMed
17.
de Rooij T, et al. Minimally invasive versus open pancreatoduodenectomy (LEOPARD-2): study protocol for a randomized controlled trial. Trials. 2018;19(1):1.CrossRefPubMedPubMedCentral
18.
Allen PJ, et al. Technical complications and durability of hepatic artery infusion pumps for unresectable colorectal liver metastases: an institutional experience of 544 consecutive cases. J Am Coll Surg. 2005;201(1):57–65.CrossRefPubMed
19.
Partelli S, et al. Evaluation of cost-effectiveness among open, laparoscopic and robotic distal pancreatectomy: a systematic review and meta-analysis. Am J Surg. 2021;222(3):513–20.CrossRefPubMed
Metadata
Title
Robotic Versus Open Hepatic Arterial Infusion Pump Placement for Unresectable Intrahepatic Cholangiocarcinoma
Authors
Britte H. E. A. Ten Haaft, MD
Stijn Franssen, MD
Roderick W. J. J. van Dorst, BSc
Merve Rousian, MD
Gabriela Pilz da Cunha, MD
Roeland F. de Wilde, MD, PhD
Joris I. Erdmann, MD, PhD
Bas Groot Koerkamp, MD, PhD
Jeroen Hagendoorn, MD, PhD
Rutger-Jan Swijnenburg, MD, PhD
Publication date
18-03-2024
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 6/2024
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-024-15127-w

Other articles of this Issue 6/2024

Annals of Surgical Oncology 6/2024 Go to the issue

Urologic Oncology

Prognostication in Lymph Node-Positive Prostate Cancer with No PSA Persistence After Radical Prostatectomy

Reconstructive Oncology

Malignant Chest Wall Tumors: Complex Defects and Their Management—A Review of 181 Cases

ASO Author Reflections

ASO Author Reflections: Advancing Early Outcome Assessment in Robot-Assisted Radical Cystectomy: RARC Tetrafecta

ASO Author Reflections

ASO Author Reflections: How to Perform a Laparoscopic Right Anterior Sectionectomy with a Combination of a Transparenchymal Glissonean Approach and Indocyanine Green Fluorescence Imaging

ASO Author Reflections

ASO Author Reflections: Changes in the Urinary Microbiome After Transurethral Resection of Nonmuscle-Invasive Bladder Cancer: Insights from a Prospective Observational Study

Global Health Services Research

Jeffrey Norton and the Legacy of the Surgical Metabolism Section of the Surgery Branch of the NCI