Hepatic artery infusion pump (HAIP) chemotherapy

Overview

Hepatic artery infusion pump chemotherapy, also called HAIP chemotherapy, targets cancer specifically in the liver. This procedure begins with the surgical implantation of a pump under the skin. The pump acts as a reservoir for chemotherapy medicine. It delivers high doses of chemotherapy directly to the liver through the liver's main artery, called the hepatic artery.

HAIP chemotherapy allows for much higher doses of chemotherapy to reach cancer than standard treatments. With HAIP chemotherapy, the liver receives the full force of the medicine while the rest of the body avoids common chemotherapy side effects, such as nausea, vomiting and fatigue.

Why it's done

HAIP chemotherapy is used to treat cancer that started in the liver, called primary liver cancer. It also is used to treat cancer that has spread to the liver from other parts of the body, called metastatic cancer. Metastatic liver cancer treated with this therapy is usually for cancers that begin in the colon.

If you have liver cancer, your doctor may recommend HAIP chemotherapy to:

• Shrink larger cancers so they can be surgically removed.
• Kill any cancer cells left behind after surgery, preventing cancer recurrence.

Studies show that HAIP chemotherapy is associated with improved survival rates for people who have this treatment after surgical removal of cancer as well as people who aren't candidates for surgery.

Risks

Risks of hepatic artery infusion pump chemotherapy, also called HAIP chemotherapy, may include:

• Bleeding or infection related to the HAIP or catheter.
• Dislodgement of the pump or catheter.
• A clot in the blood vessels.
• Problems with the pump.
• Liver damage caused by high concentrations of chemotherapy medicine.
• Stomach ulcers.
• Death, though very rare.

How you prepare

HAIP chemotherapy is a highly specialized procedure. It involves a few steps to ensure the procedure goes smoothly and the chemotherapy is effective.

Your healthcare team may do imaging tests, such as CT or MRI scans, to check your liver and the location of the cancer. Lab tests to check how well your liver works may be done to make sure your liver is healthy enough to tolerate potent chemotherapy medicine.

What you can expect

During the procedure

Surgery to place a hepatic artery infusion pump, also called HAIP, typically involves the following steps:

• Anesthesia and preparation. After you arrive for your surgery, you'll be taken to an operating room and positioned on a table. You'll be given general anesthesia medicine to put you in a sleep-like state so that you won't be aware during your operation.
• Surgical incisions. If you're having open surgery, a large cut is made in your belly. For minimally invasive surgery, several small cuts are made, just large enough to place a camera and surgical tools.
• Gallbladder removal. A standard gallbladder removal, called cholecystectomy, is done to prevent chemotherapy-related complications.
• Preparing the hepatic artery. The surgeon finds the hepatic artery and ties off nearby blood vessel branches. This ensures the chemotherapy medicine goes directly into the liver through the main artery.
• Placing the pump. The surgeon makes a cut in the lower belly or chest and creates a small pocket in the layer of tissue just under the skin, called the fascia. The pump is then stitched into the pocket. It's made of titanium metal and is about the size of a hockey puck.
• Placing the catheter. The surgeon places the pump catheter into a branch of the hepatic artery. The catheter is then stitched in place with its tip pointed at the hepatic artery. This ensures the chemotherapy medicine can flow straight into the liver.
• Testing the pump. After the pump and catheter are in place, the surgeon may test the pump system by injecting dye. This checks that the medicine only goes to the liver, rather than to other blood vessels.
• Closure of cuts. Your cuts will be closed using surgical stitches or staples.

After the procedure

Depending on whether open or minimally invasive surgery was done, you may stay in the hospital for a few days. Healing after surgery may take time. Full recovery may take a few weeks.

Here are a few basics to know about living with a HAIP:

Things to avoid

These things could affect the pump itself or the flow of medicine coming from the pump:

• Rough physical activity. Avoid any rough physical activity, such as contact sports. The pump could get hit.
• Deep-sea or scuba diving. The increased water pressure affects the flow rate of the pump. Regular swimming is fine and does not affect the pump.
• Heat. Heating pads or hot water bottles on or near the pump site can increase the flow of chemotherapy medicine. Saunas, long hot tub sessions or a lot of direct sun also can raise your body temperature and speed up pump flow.
• Elevation. Being at a high elevation or in an unpressurized airplane can increase the flow of chemotherapy medicine.

Travel

Flying while wearing a pump is generally OK. But before you fly, check with your healthcare team to avoid therapy gaps or a dry pump. The pump sets off security scanner alarms but not body scanners. Tell airport security about your pump and be sure to carry your device card.

Tell your healthcare team if you'll be 1,000 feet above sea level or higher. Altitude can affect the pump's flow. Your care team may adjust your treatment.

Results

The HAIP remains in your body as long as chemotherapy is needed. Your healthcare team monitors you regularly. This is to see how you're responding to treatment and check for possible complications.

After treatment is completed, the pump can be removed, although many people keep the pump in place if there is still evidence of cancer. Taking the pump out is a simple outpatient procedure. However, once the pump is removed, it is unlikely to be replaced.