The Whisenant/Venook article reviewed

In summary, in over 40 years, there has been minimal progress in the treatment of colorectal metastases to the liver using HAI chemotherapy, for either unresectable disease, as neoadjuvant therapy before resection, or as adjuvant therapy following resection. There is no improvement in survival as compared to systemic treatment, and the risks for toxicity from HAI therapy - especially biliary sclerosis (5% to 19%) and death from liver failure (3% to 5%), even in centers with the largest experience - are not inconsequential. Furthermore, technical complications of pump placement occur in ≥ 10% of patients, and this rate has remained stable over time. In parallel, during this same interval there have been dramatic advances in outcome from surgery, with a near-zero mortality for extended hepatic resection. [21] There have also been marked improvements in systemic and molecularly targeted chemotherapy which better address the systemic disease ultimately seen in the majority of those who initially present with colorectal metastases apparently confined to the liver.