Hepatic Artery Infusion (HAI) Pump Chemotherapy

Ryan Merkow, MD, MS, holds an HAI pump as he discusses the procedure. Dr. Merkow leads a team of surgical oncologists, medical oncologists, pathologists and other specialists who provide this advanced treatment for patients with cancer.

What is hepatic artery infusion (HAI)?

Hepatic artery infusion (also called hepatic arterial infusion pump chemotherapy, or HAI) is an innovative treatment for patients with certain metastatic colorectal and bile duct cancers that affect the liver. It’s a powerful tool for doctors to use to treat liver tumors and to further customize treatment plans.

With the help of an implantable pump, HAI delivers high doses of chemotherapy directly to the liver. It shrinks tumors with fewer side effects than traditional chemotherapy given through a vein.

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An Innovative Treatment from a Leading Cancer Center

The University of Chicago Medicine is home to a National Cancer Institute-designated Comprehensive Cancer Center, where patients have access to HAI as well as other innovative treatments and clinical trials that are not widely available at other hospitals.

The University of Chicago Medicine is among a select number of hospitals in the country to offer this advanced treatment. HAI is part of our highly respected, team-based Regional Cancer Therapies Program.

Hepatic Artery Infusion (HAI) Pump Chemotherapy for Liver Metastases

Video Transcript

Hepatic Artery Infusion Pump Chemotherapy, or HAI, is an advanced treatment for tumors that have spread to the liver due to metastatic colorectal cancer or metastatic bile duct cancer. HAI is a powerful tool to shrink liver tumors and reduces the risk of tumor recurrence. The hepatic artery infusion pump is a wireless metal pump that is placed inside the abdominal wall during a surgical procedure. The device is about the size of a hockey puck. The pump is connected to the liver via a small tube placed into a blood vessel connected to the hepatic artery. The HAI device pumps high doses of chemotherapy directly into the liver-- as much as 300 to than intravenous chemotherapy. The high doses of medication remain in the liver as opposed to circulating through the body as in traditional therapy. Over time, tumors shrink or disappear. For patients who are not yet candidates for surgery to remove tumors, HAI can shrink tumors so they can be removed with surgery. For patients who have had liver tumors removed, HAI can reduce the risk of tumor recurrence. The UChicago Medicine Comprehensive Cancer Center is one of a select number of hospitals in the nation that offers this advanced treatment. We're also leaders in hepatic artery infusion research, and are actively conducting clinical trials, with the goal of making HAI available to more patients who may benefit. Learn more about hepatic artery infusion and request an appointment at UChicagoMedicine.org/hai. [MUSIC PLAYING]

Hepatic Artery Infusion Pump: What to Expect

Understanding key facts can help you feel ready and informed for your HAI treatment journey. If you have more questions, your care team is available to support you.

How does hepatic artery infusion work?

What types of cancer are treatable with hepatic artery infusion?

HAI pumps, which are approved by the U.S. Food and Drug Administration, are available at UChicago Medicine for adults with certain types of cancers. You may be eligible if you have:

Colorectal cancer that has spread (metastasized) to the liver only or has spread to the liver and only a few other sites
Bile duct cancer that starts in the liver (intrahepatic cholangiocarcinoma)

This treatment may not be an option for you if your cancer has spread to several sites beyond the liver or if you are not healthy enough for surgery. If you are not a candidate for HAI, we also offer other life-extending treatments to people with stage 4 cancers through our Limited Metastatic Cancer Program.

What are the benefits of hepatic artery infusion?

Because chemotherapy is delivered directly to the liver, higher doses of cancer-fighting drugs — as much as 300 to 400 times higher than intravenous (IV) chemotherapy — can be used to destroy liver tumors.

These high doses of medication remain in the liver, as opposed to circulating through the body as in traditional chemotherapy. This approach reduces side effects of treatment, which can improve the quality of life for patients who may or may not yet be candidates for surgery.

For patients with metastatic colorectal cancer with liver tumors that can be removed surgically, research suggests HAI can reduce their risk of recurrence (having the liver tumors come back) and help them live longer.

For many who are not yet candidates for surgery to remove liver tumors, HAI can help control or even shrink tumors so they can have surgery.

Does hepatic artery infusion replace traditional (systemic) chemotherapy?

What happens during surgery to place a hepatic artery infusion pump?

If you are a candidate for HAI, you may receive the pump at the same time you have your liver tumors removed during a surgery called a resection. In some cases, you may just have a pump placed if your tumors are unable to be removed with surgery.

At UChicago Medicine, we can place many HAI pumps using minimally invasive, robotic-assisted surgery. Robotic techniques lead to a shorter hospital stay and a faster recovery than traditional surgery.

During the procedure, your surgeon will make a few small incisions on your abdomen. Then, we use a small video camera and highly precise robotic instruments to place a pump inside your abdominal wall, usually on the left side. You will also have a catheter placed in a blood vessel connected to your hepatic artery. This tube delivers the chemotherapy from the pump to your liver.

Placing the pump itself usually takes about two to three hours, but your surgery will take longer if you are also having tumors removed from your liver. After robotic HAI placement, many people can go home the next day, compared with three to five days after traditional surgery.

What are the risks of having a liver infusion pump?

The potential complications of surgery to place the pump vary depending on what other procedures, such as a resection to remove the liver tumors, you may have at the time of pump placement. Having HAI surgery performed by an experienced cancer surgeon, like our team at UChicago Medicine, can reduce these risks.

Although complications associated with HAI pump are uncommon, they may include:

Infections or bleeding near the pump
Narrowing of the bile duct
Injury to the hepatic artery

Our multidisciplinary team developed protocols to reduce these risks before, during and after surgery. Interventional radiologists will perform advanced imaging tests to check that your pump works correctly. Our medical oncologists and oncology pharmacists have processes to help ensure your pump delivers the right amount of chemotherapy to your liver. You will also have regular liver function tests so we can adjust the dose to optimize treatment and minimize the risks.

Will I feel the liver infusion pump in my body?

Do I need to avoid any activities with the hepatic artery infusion pump?

Although you can exercise with the HAI pump, you should avoid any contact sports or other rigorous physical activities that could damage the device. You should also avoid activities that could expose your pump to extreme heat, which could cause too much chemotherapy to be released to your liver. This includes taking very hot baths or using hot tubs, saunas and heating pads.

You can still safely travel on airplanes with an HAI pump.

How long will hepatic artery infusion treatment last?

You may receive chemotherapy through the pump for four to six months. During your treatment, you’ll need to visit the medical center every two weeks to have your pump refilled, which is also usually accompanied by lab tests and IV chemotherapy.

Refilling the pump takes about 10 minutes. A needle is used to drain the pump and refill it, but the needle does not stay in your abdomen (unlike a chemo port on the chest).

When will the HAI pump be removed?

Our care team may recommend that you keep the pump in place for six months, one year or several years, in case more treatment is needed. Instead of filling the pump with chemotherapy, we will refill it with a drug-free liquid every six weeks. This keeps the pump working properly.

When it’s time to have the pump removed, you will visit the medical center for an outpatient procedure performed by your cancer surgeon under local anesthesia. The catheter will remain permanently in the blood vessel connected to your hepatic artery.

An Innovator in Hepatic Artery Infusion Research

At UChicago Medicine, our team is conducting a clinical trial of HAI for patients with metastatic colorectal cancer that has spread to the liver but who are not candidates for surgery. We also plan to study other chemotherapy drugs to use with the pump as well as other types of patients who might benefit from this treatment.

UChicago Medicine is also part of an international consortium of academic medical centers studying survival, quality of life and other outcomes for patients who have been treated with HAI. Through this collaborative effort, we aim to make HAI as safe and effective as possible and more widely available to patients who could benefit.

Hepatic Artery Infusion Team

Ryan Merkow, MD, MS

Surgical Oncology

Blase Polite, MD

Hematology and Oncology (Cancer)