OBJECTIVE Describe the technical complications of hepatic artery infusion pump (HAIP) placement and characterize salvage rates. SUMMARY BACKGROUND DATA HAIP chemotherapy is an effective tool used in the treatment of hepatic malignancies and has become increasingly adopted at select centers. Much of the safety data is reported from small, newer programs or older, large series. METHODS Retrospective analysis of all patients who underwent HAIP placement at our institution between 2000 and 2022 was conducted. Pump salvage was defined as the ability to receive HAIP chemotherapy after a pump-associated complication. Pump failure was defined as an HAIP-related complication permanently stopping ongoing HAIP chemotherapy. RESULTS Over the study period, 2935 patients had an HAIP placed for colorectal liver metastases (n=2582, 88%), intrahepatic cholangiocarcinoma (n=294, 10%) or another malignancy (n=59, 2%). Of all patients, 759 (26%) had an HAIP-related complication, with 404/759 (53%) having their pump salvaged. The most common complications were abnormal perfusion (n=360 [12%], 285/360 [79%] salvaged), arterial pseudoaneurysm and/or hemorrhage (n=117 [4%], 7/117 [6%] salvaged), and pump-pocket infection (n=115 [4%], 60/115 [52%] salvaged). The complications with the highest salvage rates were pump-pocket seroma (n=15/16, 94%), pump-flipping (n=41/44, 93%), and pump-pocket hematoma (n=45/49, 92%). Unsalvaged complications were catheter dislodgement from vessel (n=0/47, 0%), catheter erosion into bowel (n=0/25, 0%), and arterial thrombosis (n=0/19, 0%). The cumulative incidence of pump failure at 1 year in patients receiving adjuvant therapy was 6.6%, and 4.5% among those receiving palliative therapy. CONCLUSIONS HAIP-related complications occur in about one quarter of patients, predominantly perfusion and pump-pocket complications. These are salvageable in the majority of cases with multidisciplinary interventions.
Objective: Describe the technical complications of hepatic artery infusion pump (HAIP) placement and characterize salvage rates. Summary Background Data: HAIP chemotherapy is an effective tool used in the treatment of hepatic malignancies and has become increasingly adopted at select centers. Much of the safety data is reported from small, newer programs or older, large series. Methods: Retrospective analysis of all patients who underwent HAIP placement at our institution between 2000 and 2022 was conducted. Pump salvage was defined as the ability to receive HAIP chemotherapy after a pump-associated complication. Pump failure was defined as an HAIP-related complication permanently stopping ongoing HAIP chemotherapy. Results: Over the study period, 2935 patients had an HAIP placed for colorectal liver metastases (n=2582, 88%), intrahepatic cholangiocarcinoma (n=294, 10%) or another malignancy (n=59, 2%). Of all patients, 759 (26%) had an HAIP-related complication, with 404/759 (53%) having their pump salvaged. The most common complications were abnormal perfusion (n=360 [12%], 285/360 [79%] salvaged), arterial pseudoaneurysm and/or hemorrhage (n=117 [4%], 7/117 [6%] salvaged), and pump-pocket infection (n=115 [4%], 60/115 [52%] salvaged). The complications with the highest salvage rates were pump-pocket seroma (n=15/16, 94%), pump-flipping (n=41/44, 93%), and pump-pocket hematoma (n=45/49, 92%). Unsalvaged complications were catheter dislodgement from vessel (n=0/47, 0%), catheter erosion into bowel (n=0/25, 0%), and arterial thrombosis (n=0/19, 0%). The cumulative incidence of pump failure at 1 year in patients receiving adjuvant therapy was 6.6%, and 4.5% among those receiving palliative therapy. Conclusions: HAIP-related complications occur in about one quarter of patients, predominantly perfusion and pump-pocket complications. These are salvageable in the majority of cases with multidisciplinary interventions.
Importance: The January 2025 federal executive orders (EOs) restricting diversity, equity, and inclusion (DEI) programming in government-funded and private institutions represent a structural inflection point for academic surgery. The effects extend beyond institutional compliance and directly threaten workforce sustainability, research enterprises, and editorial freedom. Objective: To evaluate the immediate and projected effects of January 2025 federal EOs on research, editorial freedom, and workforce recruitment and retention in academic surgery, and to propose adaptive strategies for mission preservation. Design: A narrative synthesis of the literature and multi-institutional experience presented during a 2026 Academic Surgical Congress Committee panel session evaluated across multiple domains: workforce, scientific research/education, patient care, and editorial ecosystems. Results: Anti-DEI EOs produced measurable disruptions across the domains examined. Regarding the workforce, survey data indicate that 50% of faculty in affected states are seeking positions elsewhere, and underrepresented-in-medicine trainees are redistributing away from institutions with policy climates perceived as hostile. In research, federal grant withdrawals and self-censorship constrain equity-focused scientific inquiry and threaten surgeon-scientist career trajectories. In publishing, editorial leaders report early signals of declining submissions addressing disparities, reflecting investigators’ concerns for possible retaliation rather than actual changes in editorial policy. Across domains, a false binary of “doubling down” versus “pivot” obscures a potentially more viable path: adaptive reframing that modifies language and programmatic infrastructure, while sustaining core missions. Conclusions: Academic surgery should preserve its mission to train a diverse surgical workforce, advance rigorous science, and deliver equitable patient care. Adaptive reframing, by embedding equity-oriented work within quality improvement, workforce sustainability, and patient safety frameworks, offers a principled strategy for navigating evolving legal constraints, without abandoning institutional missions or scientific integrity.
Objectives: The aim of this study was to investigate the association between mesh position and patient-reported outcomes, including prevalence of severe chronic pain, foreign body sensation, self-reported recurrence, and physical impact score in patients undergoing elective incisional hernia repair. Background: Patient-reported outcomes are increasingly recognized as important measures of treatment success following incisional hernia repair, yet the impact of mesh position remains uncertain. Methods: This nationwide Danish survey- and register-based cohort study was conducted within the AFTERHERNIA Project and based on the Abdominal Hernia questionnaire. All patients undergoing elective incisional hernia repair in Denmark between January 1, 2014, and March 31, 2024, were eligible for inclusion. Survey responses were linked with operative data from the Danish Ventral Hernia Database. Adjusted prevalences and means were estimated using g-computation. Results: Of 2827 eligible patients, 2348 patients responded, corresponding to a response rate of 83%. Among these, 28% of patients received onlay, 28% retromuscular, 13% preperitoneal, and 31% intraperitoneal mesh position with defect closure. Onlay was associated with a higher prevalence of foreign body sensation compared with retromuscular position (adjusted prevalence, 37.1% vs. 30.3%; difference, 6.8%; 95% CI, 0.9–12.8). No differences were observed across mesh positions regarding the prevalence of severe chronic pain, self-reported recurrence, and physical impact score. Conclusions: Onlay position was associated with a higher prevalence of foreign body sensation compared with retromuscular position, while no differences were observed regarding the prevalence of severe chronic pain, self-reported recurrence, or physical impact score.
