(HPB P1) Risk of Performing Concurrent Procedures with Hepatic Artery Infusion

Introduction Hepatic artery infusion pump (HAIP) chemotherapy is an advanced regional therapy for primary and secondary hepatic malignancies. Concurrent hepatic and/or colorectal resections at the time of HAIP placement are common, however, the additive risk of these procedures on short-term outcomes is unknown. Our objective was to characterize the safety of performing major abdominal surgery with HAIP placement. Methods The ACS NSQIP dataset from 2005-2017 was queried for patients receiving HAIPs. Cohorts were created based on concurrent procedures (major liver±colorectal, minor liver±colorectal, colorectal) and compared to HAIP placement alone. The primary outcome was death or serious morbidity (DSM) within 30 days of surgery and secondary outcomes included infectious complications, wound complications, and length of stay (LOS). Multivariable logistic regression was performed to assess the association between concurrent procedures and outcomes. Results In total, 433 patients underwent HAIP placement, of which 358 (82.6%) underwent concurrent major surgery (12.2% colorectal, 15.5% major liver, 38.6% minor liver, 2.8% colorectal+major liver, 13.6% colorectal+minor liver). Cohorts differed in age, malignancy type, and operative time. On multivariable analysis, there was increased risk of DSM with major liver resection (OR 3.42, 95% CI 1.32-8.87) and major liver+colorectal resection (OR 5.69, 95% CI 1.38-23.52) compared with HAIP placement alone. Risk of infectious complications, wound complications, and LOS >75th percentile were increased in all cohorts except minor liver resection. Conclusions Concurrent major surgery during HAIP placement is associated with increased risk of complications. This risk must be considered with respect to treatment goals and the morbidity of staged operations.