Simple method of hyperthermo‐chemo‐hypoxic isolated liver perfusion for hepatic metastases

Abstract

As a regional therapy for hepatic malignancy, we developed a simple method of isolated liver perfusion (hyperthermo-chemo-hypoxic). In the present study, the influence of this method on the hepatic tissue and other organs was experimentally evaluated and applied it to seven patients. Experimentally, all dogs survived without hepatic insufficiency and systemic toxicity. Clinically, one patient died on postoperative day 14 of hepatic failure. The reason was that liver temperature reached 43 degrees C, which seemed to be the maximum limit for thermal toxic effect to the human liver. The other six patients well tolerated the perfusion with mild increases of serum aminotransferase and total bilirubin levels and decreases of hepaprastin levels. Serum aminotransferase and total bilirubin and hepaprastin levels returned to normal levels by postoperative day 14. There were no significant differences between the isolated liver perfusion group (n = 7) and hepatectomy-only group (n = 27). Six patients were disease-free during the observation period after the perfusion. This system is a simple, useful method for treating patients with metastatic cancer limited to the liver.

The Past Decade of Experience With Isolated Hepatic Perfusion

“…In addition, multiple tumor types, often in small numbers of patients, make it difficult to draw conclusions regarding efficacy. Some studies have reported the use of IHP as an adjuvant treatment at the time of hepatic resection [38,39]; however, the majority of studies have used IHP as primary treatment for unresectable hepatic tumors ( Table 2).…”

Regional anticoagulation magnetic artificial blood vessels constructed by heparin-PLCL core–shell nanofibers for rapid deployment of veno-venous bypass

“…29,31 To improve the prognosis of refractory liver tumors, surgeons have developed many new modus operandi, such as ex vivo liver resection followed by autotransplantation, 7,34 semi-ex vivo liver resection, [35][36][37] and isolated hepatic perfusion (IHP). [38][39][40] These novel surgical procedures can improve therapeutic effects and benefit more patients, but they often require VVB to maintain hemodynamics and internal environment stability during the long anhepatic stage, which is always unpredictable in patients with liver disease. However, coagulation management during VVB is particularly difficult.…”

Modified Infusion Procedures Affect Recombinant Adeno-Associated Virus Vector Type 2 Transduction in the Liver

“…However, it is not clear if longer dwell times would further increase gene transduction. It is possible to increase the dwell time to 30 min without liver injury (Horikawa et al, 1994) but further studies are required to determine if this has any advantages. In the clinic, this outflow block approach could be performed at the time of abdominal surgery by totally isolating the liver from the blood circulation system.…”

“…Liver isolation from the blood circulation, could also be performed using a recently developed fluorographic technique (Ku et al, 1998). These two methods have advantages that could restrict the vector contact to the liver, and we could discard the remaining vector from the body by filtering the outflow from the vena cava (Horikawa et al, 1994).…”