Peri-Interventional Hemodynamic Management Strategies for Percutaneous Chemosaturation of the Liver in Metastatic Cancer

Patrick Rehn; Benjamin Tan; Jan Turra; Patrick Adler; Philipp Mayer; Dania Fischer; Mascha O Fiedler-Kalenka; Felix C F Schmitt; De-Hua Chang; Christoph Lichtenstern; Mark O Wielpütz; Hans-Ulrich Kauczor; Markus A Weigand; Maximilian Dietrich

doi:10.3390/cancers16213698

Peri-Interventional Hemodynamic Management Strategies for Percutaneous Chemosaturation of the Liver in Metastatic Cancer

Cancers (Basel). 2024 Nov 1;16(21):3698. doi: 10.3390/cancers16213698.

Authors

Patrick Rehn¹, Benjamin Tan^{1

2}, Jan Turra³, Patrick Adler¹, Philipp Mayer⁴, Dania Fischer¹, Mascha O Fiedler-Kalenka¹, Felix C F Schmitt¹, De-Hua Chang^{4

5}, Christoph Lichtenstern¹, Mark O Wielpütz^{4

6}, Hans-Ulrich Kauczor^{4

6}, Markus A Weigand¹, Maximilian Dietrich¹

Affiliations

¹ Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany.
² Department of Pediatric Cardiology and Congenital Heart Diseases, Center for Child and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany.
³ Department of Perfusion, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany.
⁴ Department of Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany.
⁵ Department of Radiology, Cantonal Hospital of Lucerne, 6000 Lucerne, Switzerland.
⁶ Translational Lung Research Center (TLRC) Heidelberg, German Center for Lung Research (DZL), Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany.

Abstract

Background: Hepatic chemosaturation for inoperable liver tumors is a palliative treatment option with a beneficial effect on survival. However, the procedure regularly leads to circulatory failure during the filtration phase, and hemodynamic management is challenging. Our study aimed to compare two different strategies for hemodynamic management during chemosaturation to develop hypotheses for improving patient care and reducing peri-interventional morbidity. Methods: We conducted a single-center retrospective cohort study including 66 procedures of chemosaturation between May 2016 and March 2024. Procedures were divided into two groups: group 1 was managed with norepinephrine as the only vasopressor and liberal use of hydroxyethyl starch (HES). Group 2 was managed with norepinephrine and vasopressin and the preferred use of balanced crystalloids. We compared these two groups with respect to hemodynamic parameters, laboratory values, and post-interventional complications. Results: The heart rate was highest and the mean arterial pressure (MAP) was lowest during the filtration phase in both groups (p = 0.868, p = 0.270). The vasoactive inotropic score (VIS) was significantly higher in group 2 during the filtration phase (31.5 vs. 89, p < 0.001). Group 1 received significantly more HES overall (1000 mL vs. 0 mL, p < 0.001). Lactate levels at admission to the ICU were higher in group 1 (22.9 vs. 14.45 mg/dL, p = 0.041). Platelet counts were lower in group 2 from directly after chemosaturation through day 2 (p = 0.022, p = 0.001, p = 0.032). The INR differed significantly directly after chemosaturation (1.13 vs. 1.26, p = 0.015). Overall, group 1 received significantly more blood products peri-interventionally. There were two bleedings and one ischemic stroke in the overall cohort. There was no peri-interventional mortality. Conclusions: Advanced hemodynamic management ensures low peri-interventional mortality and morbidity. High-dose vasopressors, including vasopressin and the preferred use of balanced crystalloids, are sufficient to stabilize circulatory function during chemosaturation.

Keywords: anesthesia; catecholamines; chemosaturation; hemodynamics; shock; uveal melanoma.

Grants and funding

This study was funded by institutional resources. There was no external funding. For the publication fee we acknowledge financial support by Heidelberg university.