HAI is a type of regional chemotherapy made possible when a surgical oncologist (cancer surgeon) places a wireless, metal pump — about the size of a hockey puck — inside the abdominal wall, similar to a chemo port. The device pumps chemotherapy directly to the liver through a small tube (catheter) placed in a blood vessel connected to the hepatic artery, the blood vessel that goes into the liver.

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.

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.

No. Most people with HAI pumps still need IV chemotherapy to kill cancer cells outside of the liver. However, they often can have lower doses of chemotherapy, which means they have fewer side effects.

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.

During the procedure, your surgeon will 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. Most people can return home in three to five days after surgery.

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 those 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 team has 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.

Some people can feel or see the pump in their abdomen, but most don’t notice it.

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.

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, in which the needle often stays in place for several days after treatment).

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.