Michael J. Cavnar, MD, an assistant professor of surgery at the University of Kentucky Markey Cancer Center, discusses the use of hepatic artery infusion pumps in patients with colorectal cancer (CRC) with liver metastases.

Hepatic artery infusion pumps have been in use since the 1970s, Cavnar says. The device capitalizes on the fact that liver metastases get their blood supply from the artery that feeds the liver. Specifically, the liver has a dual inflow of blood, one-third of which comes from the hepatic artery and two-thirds come from the portal vein, explains Cavnar. For reasons that are not currently understood, CRC liver metastases only receive blood flow from the hepatic artery, according to Cavnar.

Starting in the 1970s, chemotherapy was infused directly into the liver. The rationale behind this is that a higher dose can be administered without added toxicity to the rest of the body. The dose that would need to be administered to a vein or meta port to achieve the same level of response would be incredibly toxic to the patient, Cavnar says. Instead, the pump allows for the administration of a small amount of chemotherapy at a high concentration into the liver to achieve a dramatic response, Cavnar concludes.

Videos

Michael J. Cavnar, MD, discusses the use of hepatic artery infusion pumps in patients with colorectal cancer with liver metastases.



Dr. Cavnar on the Use of Hepatic Artery Infusion Pumps in CRC With Liver Metastases

Michael J. Cavnar, MD, assistant professor of surgery, University of Kentucky Markey Cancer Center, discusses ​surgical differences between right- and left-sided tumors in colorectal cancer (CRC).

Right-sided ​CRC tumors are the easiest to remove surgically​, explains Cavnar. ​Unless the tumor is bulky or advanced, patients who present with a right-sided tumor can likely undergo laparoscopic surgery to remove the tumor, Cavnar says. Moreover, laparoscopic surgery typically requires patients to be hospitalized for 3 to 4 days and the recovery period is usually short. 

Conversely, left-sided tumor ​resections tend to be more complicated​, says Cavnar. Tumors that are located on the upper​-left region of the colon are usually able to ​be remove​d surgically and don’t ​involve a diverting ileostomy. However, neoadjuvant radiation may be required in rectal cancer. Moreover, ​surgical anastomosis has a higher ​risk in this setting and is frequently protected with a diverting ileostomy, which requires an additional surgery to reverse, Cavnar concludes.

Michael J. Cavnar, MD, discusses ​surgical differences between right- and left-sided tumors in colorectal cancer. 

Dr. Cavnar on Surgical Differences Between Right- and Left-Sided Tumors in CRC

Michael J. Cavnar, MD, assistant professor of surgery, University of Kentucky Markey Cancer Center, discusses the roles of chemotherapy and surgery in metastatic colorectal cancer (mCRC).

Historically, patients with mCRC were not candidates for surgery, Cavnar says. Instead, these patients would receive palliative chemotherapy, with the goal of prolonging survival rather than cure. 

However, some patients with metastatic disease have a low disease burden that can be controlled and reduced with chemotherapy, Cavnar explains. In these situations, surgical removal of residual disease by liver or lung resection should be considered, says Cavnar. Additionally, patients who have residual disease within the peritoneal cavity may undergo cytoreductive surgery or hyperthermic intraperitoneal chemotherapy, concludes Cavnar.

Michael J. Cavnar, MD, discusses the roles of chemotherapy and surgery in metastatic colorectal cancer.  



Dr. Cavnar on the Roles of Chemotherapy and Surgery in Metastatic CRC 

Michael J. Cavnar, MD, assistant professor of surgery, University of Kentucky Markey Cancer Center, discusses the importance of multidisciplinary care in colorectal cancer (CRC).

A multidisciplinary team is crucial in determining the optimal care for a patient with CRC, says Cavnar.

Many patients ​with CRC present with abdominal discomfort​ or pain, says Cavnar. If a bowel obstruction is discovered, patients may undergo surgery. Moreover, in some cases, emergency surgery may be required.

An initial work up may reveal liver metastases​, Cavnar says. Alternatively, ​sites of metastatic disease could be diagnosed years after identifying the primary tumor, Cavnar explains.

Once a patient is diagnosed with metastatic CRC, imaging ​with MRI, CT scan, or another modality plays a critical role in determining the extent of the disease. ​Consulting a radiologist may aid in selecting the optimal imaging strategy for each individual patient, Cavnar concludes.

Michael J. Cavnar, MD, discusses the importance of multidisciplinary care in colorectal cancer. 

Dr. Cavnar on the Importance of Multidisciplinary Care in CRC

Michael J. Cavnar, MD, assistant professor of surgery, University of Kentucky Markey Cancer Center, discusses the management of patients with liver metastas​es in colorectal cancer (CRC).

Adapting treatment for patients with CRC and liver metastases can be complicated and requires collaboration from a multidisciplinary tumor board, says Cavnar.

Historically, patients with CRC who have liver metastases would have mainly received palliative care, says Cavnar. 

However, due to improv​ed response rates with chemotherapy, more patients in this population are eligible for potentially curative surgery, Cavnar concludes.

Michael J. Cavnar, MD, discusses the management of patients with liver metastas​es in colorectal cancer. 

Michael J. Cavnar, MD

Articles

Dr. Cavnar on the Use of Hepatic Artery Infusion Pumps in CRC With Liver Metastases

Dr. Cavnar on Surgical Differences Between Right- and Left-Sided Tumors in CRC

Dr. Cavnar on the Roles of Chemotherapy and Surgery in Metastatic CRC

Dr. Cavnar on the Importance of Multidisciplinary Care in CRC

Dr. Cavnar on the Management of Liver Metastases in CRC