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Comparative Study
. 2025 May;32(5):3488-3498.
doi: 10.1245/s10434-025-16915-8. Epub 2025 Jan 28.

Robotic Versus Open Placement of Hepatic Artery Infusion Pumps

Lauren E Schleimer  1 , Annie Liu  2 , Hannah L Kalvin  3 , Ahmad Bashir Barekzai  1 , Ankur P Choubey  1 , Joslyn Jung  1 , Rubiya Haque  1 , William R Jarnagin  1 , Vinod P Balachandran  1 , Ruben Geevarghese  4 , Brett Marinelli  4 , Mithat Gonen  3 , Jeffrey Drebin  1 , Peter J Allen  2 , Michael I D'Angelica  1 , Alice C Wei  1 , Sabino Zani  2 , T Peter Kingham  1 , Michael E Lidsky #  2 , Kevin C Soares #  5
Affiliations
Comparative Study

Robotic Versus Open Placement of Hepatic Artery Infusion Pumps

Lauren E Schleimer et al. Ann Surg Oncol. 2025 May.

Abstract

Background: A growing number of centers offer hepatic artery infusion pump (HAIP) chemotherapy for advanced liver malignancies. While small series have demonstrated feasibility of robotic HAIP placement, comparison of outcomes with open placement is lacking. We compared outcomes after robotic versus open HAIP placement.

Methods: We retrospectively reviewed HAIP placement without concurrent hepatectomy at Memorial Sloan Kettering Cancer Center from 1 January 2011 to 15 September 2022, and Duke Health from 1 November 2018 to 18 May 2023. Patients with prior liver surgery or who required catheterization of a non-standard vessel were excluded. Propensity score matching weights (PSMW) were calculated using age, sex, race, body mass index, American Society of Anesthesiologists class, neoadjuvant chemotherapy, colorectal procedure, and institution. Survey-weighted generalized linear models assessed the relationship between approach and outcomes.

Results: Of 2002 consecutive HAIP placements, 819 (645 open/174 robotic) met the inclusion criteria. A higher proportion of open procedures involved combined colorectal procedures; other patient characteristics were similar. Overall, 15% of patients experienced an HAIP-specific complication and 12% required re-intervention; 2.7% had HAIP failure ≤ 90 days. After PSMW, the robotic approach had a longer operative time (β = 68 min, 95% confidence interval [CI] 55-81, p < 0.001) but shorter length of stay (β = - 1.8 days, 95% CI - 2.3 to 1.3, p < 0.001). The robotic approach was associated with increased HAIP-specific complications (odds ratio [OR] 1.72, p = 0.025) and re-intervention (OR 2.33, p < 0.001), with no difference in time to initiation of HAIP chemotherapy or HAIP failure.

Conclusions: Robotic HAIP placement was associated with increased postoperative complications and significantly shorter length of stay, with similar time to initiation of HAIP therapy. There was no difference in the rate of early HAIP failure versus the open approach. These results suggest robotic HAIP placement is feasible and effective.

Keywords: Colorectal cancer liver metastasis; HAIP; Hepatic artery infusion pump; Intrahepatic cholangiocarcinoma; Liver cancer; Liver-directed therapy; Propensity score matching weights; Robotic HAIP placement; Robotic surgery.

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Conflict of interest statement

Disclosures: Alice C. Wei reports receiving consulting fees from Histosonics and institutional clinical trial funding from Ipsen. Sabino Zani reports consulting for Asensus Surgical. Jeffrey Drebin reports equity shares in ALNY, IONS and ARWR, purchased from a broker. Lauren E. Schleimer, Annie Liu, Hannah L. Kalvin, Ahmad Bashir Barekzai, Ankur P. Choubey, Joslyn Jung, Rubiya Haque, William R. Jarnagin, Vinod P. Balachandran, Ruben Geevarghese, Brett Marinelli, Mithat Gonen, Peter J. Allen, Michael I. D’Angelica, T. Peter Kingham, Michael E. Lidsky, and Kevin C. Soares have no conflicts of interest disclosures to report that may be relevant to the contents of this study.

Figures

Fig. 1
Fig. 1
Selection of robotic and open cohorts for propensity score matching weight comparison. aStudy period was 1 January 2011 through 15 September 2022 at MSK; 1 November 2018 through 18 May 2023 at Duke. bUnable to assess HAIP function postoperatively, as the treatment plan changed due to the results of the intraoperative biopsy; no perfusion study was performed and HAIP was never used. HAIP Hepatic artery infusion pump, GDA Gastroduodenal artery, MSK Memorial Sloan Kettering Cancer Center, Duke Duke Health
Fig. 2
Fig. 2
Comparison of standard mean differences pre- and post-matching weights for A patients who underwent HAIP placement alone (n = 445 pre-weighting) and B the entire cohort (n = 819 pre-weighting). HAIP Hepatic artery infusion pump, BMI Body mass index, ASA American Society of Anesthesiologists
Fig. 3
Fig. 3
Forest plots of 90-day postoperative outcomes from propensity score matching weight analysis. OR Odds ratio, CI Confidence interval, HAIP Hepatic artery infusion pump
See this image and copyright information in PMC

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