A safe and fast technique for isolated hepatic perfusion.

Isolated hyperthermic antiblastic perfusion of the liver is currently gaining acceptance among surgeons and oncologists as a treatment for multiple unresectable liver metastases when conventional chemotherapy failed to halt progression of the disease [1]. Currently, new promising drugs are under investigation to further improve the efficacy of the treatment [2]. Colorectal cancer is the most sensitive histology to such a therapy [3] but other primary tumors seems to benefit as well [4–6]. Herein we describe our modified technique of isolated hepatic perfusion that is simpler and faster compared to the initial ones reported in the literature. Previous techniques [7] of isolated hepatic perfusion included total vascular isolation of the liver with portal and systemic venous by pass. The venous by pass was performed either using a cut-down technique or by percutaneous cannulation of the femoral vein. Another important step of previous described techniques was the continuous intra-operative monitoring of complete vascular isolation of the liver by 131-I labeled serum albumin. The technique we describe herein does not include portal vein by pass but shunting of the blood is limited solely to the inferior vena cava. Complete vascular isolation of the liver is demonstrated by a steady volume of the reservoir during the entire procedure, without using labeled albumin.