S15 Ep13: Hepatic Artery Infusion Refines Liver-Directed Care for GI Cancers: With Gregory J. Tiesi, MD, FACS, FSSO; Anthony Scholer, MD, FACS, FSSO; Benjamin Jon Golas, MD, FACS; and Eric Pletcher, MD

Dec 9, 2025

In a deep dive into hepatic artery infusion (HAI), guests include Anthony Scholer, a surgical oncologist leading HAI programs, and Eric Pletcher, a specialist in complex oncology procedures. They explore how HAI innovatively targets liver tumors by utilizing the liver's dual blood supply, enhancing treatment efficacy for colorectal metastases and cholangiocarcinoma. The discussion covers patient selection criteria, therapeutic advantages, and ongoing research into new drug combinations and immunotherapy, positioning HAI as a promising avenue in liver-directed cancer care.

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INSIGHT

Higher Intrahepatic Response Drives Outcomes

HAI yields higher intrahepatic objective responses and better local control than systemic therapy alone.
Improved conversion to resectability drives long-term outcome benefits in colorectal and cholangiocarcinoma liver disease.

ADVICE

Map Arterial Anatomy Before Pump Placement

Do perform thorough preoperative CT angiography to map arterial anatomy and assess liver health before pump placement.
Do confirm intraoperative and postoperative mapping (methylene blue/ICG and nuclear medicine) to rule out extrahepatic perfusion.

ADVICE

Cholecystectomy And Early Treatment Steps

Do remove the gallbladder during pump implantation to prevent post-treatment cholecystitis.
Do start FUDR via the pump with concurrent systemic therapy about two weeks after surgery, typically for six cycles.

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In this episode, Gregory J. Tiesi, MD, FACS, FSSO, hosted a discussion about the use of hepatic artery infusion (HAI) in colon cancer and liver cancer management. Dr Tiesi is the medical director of Hepatobiliary Surgery at the Hackensack Meridian Jersey Shore University Medical Center in Neptune, New Jersey. He was joined by:

Anthony Scholer, MD, FACS, FSSO, a surgical oncologist specializing in hepatobiliary surgery, at Hackensack Meridian Medical Group and Jersey Shore University Medical Center in Neptune, New Jersey
Benjamin Jon Golas, MD, FACS, regional chief of Surgical Oncology for Hackensack Meridian Health’s Central Region, surgical director of Oncology Services at Jersey Shore University Medical Center, vice chair of Surgery at Jersey Shore University Medical Center Cancer Surgery, and an associate professor of surgery at the Hackensack Meridian School of Medicine in Nutley, New Jersey
Eric Pletcher, MD, a surgeon specializing in Complex General Surgical Oncology at Hackensack Meridian JFK University Medical Center in Edison

Drs Tiesi, Scholer, Golas, and Pletcher explained that HAI is a longstanding regional therapy used for treating primary and metastatic tumors to the liver, notably unresectable colorectal liver metastases and intrahepatic cholangiocarcinoma. The physiologic mechanism of this treatment leverages the dual blood supply of the liver, capitalizing on the fact that these malignancies primarily derive their perfusion from the hepatic artery, the experts noted. They emphasized that by delivering chemotherapeutic agents, such as floxuridine, directly via the gastroduodenal artery, HAI concentrates drug exposure at the tumor site, maximizing antitumor effect and minimizing extrahepatic toxicity.

They explained that patient selection requires fitness for surgery and good liver function, excluding those with cirrhosis or portal hypertension. They also noted that the procedure involves implanting a subcutaneous pump, followed by rigorous intraoperative and postoperative nuclear medicine studies to confirm the absence of extrahepatic perfusion. Evidence supports that HAI combined with systemic therapy achieves higher intrahepatic objective responses, improves local disease control, and enhances conversion to resectability, correlating with improved long-term survival, the experts reported. However, potential complications include pump pocket infections, biliary sclerosis, and gastric ulcers, they added. The experts concluded by highlighting that establishing an HAI program necessitates a robust, multidisciplinary approach involving surgical oncology, medical oncology, and interventional radiology.