Portal Venous Infusion

As the liver is the main site of metastatic disease, several investigators have suggested that most of the benefit of adjuvant therapy is from its effects on the liver. All of the commonly used drugs cannot be given in oral form so that route to the liver is not available. However, it is possible to implant a catheter at the time of surgery into a small branch of the portal vein (eg in the mesentry of the small bowel). Then the chemotherapy is administered via this for 1 week post op.

This procedure was evaluated in the AXIS trial and was shown to add about +5% benefit above the standard 5-FU and folinic acid regimen.