Comparative Assessment of Isolated Liver Chemoperfusion Techniques

Abstract

Background. Metastatic liver injury is a  distinct oncological problem, irrespective of primary malignancy. Resection surgery is not always feasible in such patients. Isolated liver chemoperfusion is a promising treatment option in multiple small-focal metastatic organic lesions. This technique is technically complex, which limits its broader evaluation and adoption in clinical practice. The diversity of isolated liver chemoperfusion techniques does not allow an adequate assessment of world experience and requires further research. The important considerations with introducing isolated liver chemoperfusion are: an optimal surgical technique, liver isolation control method, as well as physiological arterial and portal blood flow maintenance.Materials and methods. A total of 21 patients were surveyed over June 2020 — December 2021. The patients were divided into 3 prospective cohorts: A) arteriocaval chemoperfusion, midline laparotomy access, technical-guided liver isolation, B) arteriocaval chemoperfusion, “in J laparotomy” access, ICG-guided liver isolation, C) arterio-porto-caval chemoperfusion, “in J laparotomy” access, ICG-guided liver isolation. A procedure’s tolerance was assessed with: the duration of surgery, postoperative ICU bed-days, total postoperative bed-days, hepatic cytolysis rates, chemotherapy side-effects severity.Results and discussion. The duration of surgery shortened with “in J laparotomy”. Haemotoxicity did not differ between cohorts A and B, albeit appearing significantly lower in cohort C. The cytolytic syndrome duration statistically significantly reduced in C vs. A and B cohorts.Conclusion. All the isolated liver chemoperfusion techniques employed are patient-safe. In ICG-guided liver isolation, the agent leakage into systemic blood flow is less likely, indicating a lower haemotoxicity. Arterioportal isolated chemoperfusion is more physiological compared to other techniques, thus facilitating lower hepatotoxicity. The use of “in J laparotomy” significantly reduces liver mobilisation and vascular cannulation times.