Percutaneous hepatic perfusion in patients with metastatic liver cancer: anesthetic, hemodynamic, and metabolic considerations

Annals of Surgical Oncology
Ning MiaoZenaide M N Quezado

Abstract

Percutaneous hepatic perfusion (PHP), a regional cancer therapy, entails insertion of percutaneous catheters to isolate hepatic vasculature and enable simultaneous hepatic venous hemofiltration of high-dose chemotherapy. PHP has been shown to be safe and to benefit some patients with liver metastases. We examined hemodynamic and metabolic changes as well as anesthetic implications during PHP in patients with metastatic liver cancer enrolled in clinical trials of escalating doses of melphalan between 2001 and 2006. Fifty-one patients underwent 136 PHPs with general anesthesia. Diagnoses included neuroendocrine tumors, melanoma, and metastatic carcinomas. Based upon available data derived from all procedures, incorporating multiple procedures per patient, after occlusion of the inferior vena cava and during hepatic perfusion, there were decreases in mean arterial (-15.4 +/- 1 and -7.4 +/- 1 mmHg, respectively) and central venous pressure (-5.4 +/- 0.3 and -5.6 +/- 0.3 mmHg) and increases in heart rate (11 +/- 1 and 13.4 +/- 0.9 bpm) (all p < 0.0001) which resolved with completion of the procedure. During vascular isolation, patients received norepinephrine (13% of procedures), phenylephrine (70%), or both agents (11%). During hep...Continue Reading

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Citations

Mar 4, 2014·Journal of Visceral Surgery·O FacyP Ortega Deballon
Aug 16, 2014·European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology·L B J van IerselC J H van de Velde
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Jun 1, 2010·Journal of Surgical Oncology·Mahmoud N Kulaylat, John F Gibbs
Oct 30, 2013·Journal of Surgical Oncology·Maki Yamamoto, Jonathan S Zager
Mar 7, 2014·Journal of the European Academy of Dermatology and Venereology : JEADV·K EichlerM G Mack
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Jul 25, 2014·Therapeutic Advances in Medical Oncology·Srinevas K ReddyH Richard Alexander
Oct 31, 2021·Cardiovascular and Interventional Radiology·Rhea VeelkenFlorian van Bömmel

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