Isolated hepatic perfusion as a treatment for liver metastases of uveal melanoma

J Vis Exp. 2015 Jan 25:(95):52490. doi: 10.3791/52490.

Abstract

Isolated hepatic perfusion (IHP) is a procedure where the liver is surgically isolated and perfused with a high concentration of the chemotherapeutic agent melphalan. Briefly, the procedure starts with the setup of a percutaneous veno-venous bypass from the femoral vein to the external jugular vein. Via a laparotomy, catheters are then inserted into the proper hepatic artery and the caval vein. The portal vein and the caval vein, both supra- and infrahepatically, are then clamped. The arterial and venous catheters are connected to a heart lung machine and the liver is perfused with melphalan (1 mg/kg body weight) for 60 min. This way it is possible to locally perfuse the liver with a high dose of a chemotherapeutic agent, without leakage to the systemic circulation. In previous studies including patients with isolated liver metastases of uveal melanoma, an overall response rate of 33-100% and a median survival between 9 and 13 months, have been reported. The aim of this protocol is to give a clear description of how to perform the procedure and to discuss IHP as a treatment option for liver metastases of uveal melanoma.

Publication types

  • Video-Audio Media

MeSH terms

  • Antineoplastic Agents, Alkylating / administration & dosage
  • Chemotherapy, Cancer, Regional Perfusion / methods*
  • Extracorporeal Circulation
  • Heart-Lung Machine
  • Hepatic Artery
  • Humans
  • Liver Neoplasms / blood supply
  • Liver Neoplasms / drug therapy*
  • Liver Neoplasms / secondary*
  • Melanoma / drug therapy*
  • Melanoma / pathology*
  • Melphalan / administration & dosage
  • Portal Vein
  • Uveal Neoplasms / drug therapy*
  • Uveal Neoplasms / pathology*
  • Vascular Access Devices

Substances

  • Antineoplastic Agents, Alkylating
  • Melphalan

Supplementary concepts

  • Uveal melanoma