Hepatic arterial infusion chemotherapy: a review with technical notes

Combined hepatic artery infusion (HAI) and systemic chemotherapy have demonstrated its clinical efficacy in prolonging overall survival in unresectable intrahepatic cholangiocarcinoma and as a conversion to treatment strategy in a small proportion of patients. The utilization of HAI chemotherapy is restricted by the scarcity of surgeons and oncologists who are well-experienced in its use. This represents a significant drawback of this treatment method. In recent years, a solid push to expand its use, mainly in the United States and recently also in Europe, has been made possible by the HAI Consortium Research Network. Results of ongoing Clinical Trials are eagerly awaited to give the basis for further expansion of this technique and oncological treatment outside of historically established centers. In this technical note review, we aim to give a brief historical description of the origins and evolution of intra-arterial chemotherapy for unresectable intrahepatic cholangiocarcinoma. We will, therefore, discuss the surgical technique by providing some tips and tricks without neglecting the difficulties that may be encountered.