Hepatic Arterial Infusion for Malignancy

Michael D’Angelica, MD, Department of Surgery, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New Nork, NY, USA.Michael Lidsky, MD, Division of Surgical Oncology, Department of Surgery, Duke University, Durham, NC, USA.

• Part I. History of HAI.- Philosophy and rationale for liver-directed therapy (includes history of catheter-based chemotherapy delivery).- Transarterial therapies and Early History/Trials of HAI.- Device Development: development of implantable reservoir-based pump.- Optimization of therapy:  Drug development, pharmacokinetics, pharmacodynamics.- Part II. HAI Perioperative and Operative Considerations.- Preoperative Evaluation.- Conduct of Open HAIP placement.- Conduct of MIS HAIP placement.- Concurrent procedures and perioperative care/postoperative considerations.- Pre-HAI Perfusion Scans.- HAI Pump-Specific Complications and Management.- Part III. HAI Delivery.- HAI Drugs.- Concurrent Systemic Therapy.- Duration, maintenance, and secondary use of HAI.- Part IV. HAI Patient Selection and Efficacy.- Unresectable CRLM.- Adjuvant HAI for resected CRLM.- Intrahepatic cholangiocarcinoma.- Other indications: HCC, NET, Breast, Pancreas Cancer.- Part V. Long-Term Consequences of HAI.- Biliary sclerosis.- Hepatic Failure.- Termination of HAI and Pump Removal.- Transplant after HAI.- Part VI. Starting a New HAI Program.- Recruitment of a team.- Device and drug procurement.- Regulatory/IRB Considerations.- Training a new HAI team.- HAI Site Visits.- Early Patient Selection.- Patient education.- International Perspective.- Part VII. The Future of HAI.- Device development: the future.- Drug development.- Part VIII. Alternative Approaches to HAI delivery.- Complete percutaneous delivery.- Reservoir-less ports.- Part IX. HAI Video Atlas.- Open HAI pump implantation.- Robotic HAI pump implantation.- Accessing HAI pump reservoir.- Accessing HAI pump bolus port.- Priming the HAI pump.