By Andrew Gorosko

Approximately the size of hockey pucks, implantable titanium chemotherapy infusion pumps have long been used to provide cancer patients with treatment to attack malignant tumors.

Using a “minimally invasive” surgical approach, a team of physicians at Danbury Hospital recently adapted how such implanted pumps can be used, in seeking to reduce the discomfort and adverse side effects, that patients experience while undergoing chemotherapy.

On March 18, Pierre F. Saldinger, MD, who is the chief of general surgery at the hospital and a specialist in surgery of the liver, pancreas and bile ducts; and Patrick Malloy, MD, who is the chairman of the radiology department and who works as an interventional radiologist, performed the first “minimally invasive” surgery in this country to implant a chemotherapy pump for cancer treatment. An unidentified adult male was the patient.

The surgery is part of Danbury Hospital’s cancer research protocol, formally known as “Transintercostal Placement of Hepatic Artery Infusion Pump for the Treatment of Metastatic Tumors of the Liver.” The treatment is intended for selected patients with colon cancer that has spread to the liver.

Dr Saldinger is the principal investigator in the study. The study’s co-investigators are Dr Malloy and John Pezzimenti, MD, who is the hospital’s director of cancer medicine and the chief of the hematology/oncology unit at the hospital.

Through the newly developed surgical technique, patients may avoid the major surgery required to conventionally implant such a chemotherapy pump in the abdomen. The minimally invasive approach is intended to reduce surgical pain, while still delivering the cancer-killing chemicals directly to tumors in the liver.

Dr Saldinger said that the ideal treatment for liver cancer is the surgical removal of the diseased portion of the organ. Unfortunately, that is not always medically possible. Instead of such surgery, chemotherapy may be employed to fight the cancer with drugs.

The current standard treatments for colon cancer that has spread to the liver include conventional general chemotherapy, or alternately, involve the surgical placement of a chemotherapy pump within the abdomen via major abdominal surgery, according to Dr Pezzimenti.

Some patients, in their weakened states, are not able to endure such major surgery, so Dr Saldinger developed surgical techniques to install the pump that would be “minimally invasive” for the patient, involving minimal surgical cutting.

When applicable, implanting a chemotherapy pump is well worth the effort, the doctor explained, noting that the direct, localized, high-dosage chemotherapy, which is possible with an implanted pump, causes more than 50 percent of treated tumors to shrink.

 The gas-powered pump continuously delivers chemotherapy drugs to the tumor. The implanted pump can be serviced and replenished with chemotherapy drugs from outside the patient.

Eventually, such pumps installed via minimally invasive surgery may be used to treat other bodily organs for cancer, or may be used for other types of medical treatments, Dr Saldinger said.

In the minimally invasive surgery recently pioneered by Dr Saldinger and Dr Malloy, the doctors made a two-inch incision on the left side of the patient’s abdomen. The doctors channeled a small tube through the hepatic artery, which supplies blood to the liver. That tube was then linked to the titanium pump holding the chemotherapy drugs. The pump was then surgically placed inside the patient through another small incision on the left side of the abdomen, near a rib.

Dr Saldinger noted that placing the pump in that location is intended to avoid the major surgery that is required when a pump is placed in the abdomen through open abdominal surgery.

The continuous-action pump, which dispenses about one milliliter of liquefied drugs daily, may be replenished with drugs every two to three weeks, as needed. The pump is manufactured by Arrow International, Inc.

A minimally invasive approach to chemotherapy pump implantation means less bleeding, less pain, and a generally better quality of life for the patient who is undergoing treatment, Dr Saldinger said.

“I wanted to find a way to make it easier on the patient,” he said.

“We hope that this technique will significantly decrease patient morbidity and potentially expand the treatment options for people with cancer,” according to Dr Malloy.