Hepatic Arterial Infusion

What is Hepatic Arterial Infusion (HAI)?

HAI is a type of regional chemotherapy to treat advanced colorectal cancer that has spread to the liver. It delivers a high dose of chemo directly into the liver's blood supply using a pump that surgeons implant under your skin.

In most cases, people have already had surgery on their colon or rectum. They've also had systemic chemo through an IV line that travels all through the body.

HAI may:

• Help some people with liver metastases live longer.
• Limit negative side effects.
• Improve quality of life.

Doctors may use other treatments along with HAI therapy, including:

• Isolated hepatic perfusion (IHP).
• Yttrium-90 internal radiation.
• Systemic chemotherapy.

Your doctor will work with you on treatment goals to meet your needs.

Hepatic Arterial Infusion Benefits

• Research shows that HAI may help people live longer, especially those with advanced colorectal cancer.
• HAI delivers the chemo directly to your cancer cells, limiting how much of the drug reaches healthy parts of your body.

Hepatic Arterial Infusion Risks and Side Effects

Although HAI is less likely to cause side effects like systemic chemo, the possibility of side effects still exists.

These side effects may include:

• Nausea
• Vomiting
• Diarrhea
• Swelling of the liver
• Damage to the bone marrow (myelosuppression)

Doctors must perform surgery to install the HAI pump and connect it to your hepatic artery.

Possible risks of any surgery include:

• Infection
• Blood loss
• Blood clots
• Other problems

Other risks — specific to HAI surgery — are rare but may include:

• Injury to the artery.
• Leakage of chemo into nearby organs.
• Inflammation of the stomach or nearby organs.
• Pump pocket inflammation or infection.

Cancers We Treat with Hepatic Arterial Infusion

The most common use of HAI is to treat primary liver cancers like cholangiocarcinoma and metastatic colorectal cancer.

How to Prepare for Hepatic Arterial Infusion

Your surgeon will give you specific guidance on how to prepare for your cancer surgery.

These guidelines may include the following:

• Complete any necessary preoperative testing at least a week before your surgery date. These might include blood and urine tests, a chest x-ray, an EKG, and others as needed.
• Stop taking aspirin, blood thinners, or anti-inflammatory drugs 10 days before your surgery. Your doctor will let you know if and when you should stop vitamins or other supplements.
• Stop eating and drinking at least eight hours before your surgery. Your doctor may let you take medicine with a sip of water (no coffee, tea, or juice) the morning of surgery. If you have diabetes, ask whether you should take your diabetes medications on surgery day.

What Can I Expect During and After Hepatic Arterial Infusion?

HAI surgery can be either open or robotic. Your surgeon will discuss these options with you in advance.

Your HAI surgery will start with an arteriogram, an imaging test in which doctors check your liver's arteries to plan the operation.

Next, your surgeon will:

• Remove your gallbladder, if you still have it.
• Insert the HAI pump into the artery.
• Perform a dye injection test to make sure the chemo will go where it's needed.

Your surgery will last between two and a half to three hours.

You can expect a hospital stay of about four days post-op. You may need to stay longer if have any complications after surgery.

Once your surgical wound starts to heal, your doctor may send you home with your first dose of HAI chemo. You will receive more doses as needed during the coming weeks and months, based on the chemo drug you get.

Because HAI is complex, it's best to choose an experienced cancer center for your treatment.

UPMC Hillman Cancer Center's surgeons have more than 20 years of experience with HAI and minimally invasive surgery.