During 3 days before intervention surgery, examinations should be taken including blood/urine/stool routine test, liver and kidney function test, coagulation function, electrolyte test, and tumor markers (CEA). Liver MRI or CT scanning should be carried on within 2 weeks before surgery. If being accompanied with other distant metastasis, the appropriate imaging should also be carried on.

Inform patients and their families of the surgery process, postoperative reaction, and possible complications. Let the patients sign the consent and fast 4 h before surgery. Administer 10 mg intramuscular injection of diazepam 30 min before surgery. Prepare the skin puncture site.

18G needle, 4F or 5F vascular sheath, 0.035 or 0.038 smooth guide wire, 4F or 5F varieties of preforming catheter, such as the celiac artery, hepatic artery, and left gastric artery catheters, the 3F microcatheter, etc. (cobra, RH, RLG, Simmons I, Simmons II, multipurpose, etc.).

Similar to the history of intravenous chemotherapy for colorectal cancer liver metastasis, 5-FU/FUDR + LV is the most widely and deeply studied drug in the arterial treatment. Since the 1980s, many institutions have carried on a large number of random control studies on 5-FU/FUDR + LV through arterial and intravenous administration. Some scholars [5, 6] summarized seven groups of the classic studies. The results showed that the effective rates of arterial and intravenous administrations were 41 and 14 %, with a significant difference, but the survival terms of the two had no significant difference. They thought the reason that the survival terms of the two were similar was that some patients in the intravenous administration group crossed over to the arterial treatment group after lesion progress, while some patients in the arterial administration group crossed over to the intravenous administration group due to port catheter system (PCS) implantation failure or complications or other factors. The arterial administration group’s extrahepatic metastasis lesion has not been well controlled. Kemeny et al. [7] randomly divided 135 patients with colorectal cancer liver metastasis into two groups, arterially and intravenously administered with FUDR and LV. The effective rate of the arterial administration group was 47 %, significantly higher than 24 % of the intravenous group (P = 0.012). The former’s median survival term (P = 0.0034) and median progress time (P = 0.034) were significantly longer than the latter.

In the 1990s, the appearance of oxaliplatin and irinotecan makes the colorectal cancer chemotherapy embark on a new level and makes the effective rate of the colorectal cancer liver metastasis remarkably increased, and the survival term is significantly prolonged. Many scholars studied the two drugs’ arterial administration. Dzodica et al. [8] studied the arterial and intravenous administration of oxaliplatin in VX2 rabbit model. The peripheral peak concentration of arterial administration was significantly lower than that of intravenous administration, which indicated that the arterial administration had a relatively higher therapeutic index. Irinotecan is a kind of prodrug, which must be catalyzed into active product 7-ethyl-10-hydroxycamptothecin (SN-38) by the carboxylesterase in the human body to play a pharmacological effect. Because the liver carboxylesterase concentration was higher than that in other organs, the conversion rate of SN-38 by the hepatic artery administration was significantly higher than that by intravenous administration (P = 0.015) so that the former’s hepatic SN-38 concentration was higher than that of the latter [9]. Irinotecan, oxaliplatin, and FUDR all have good effects on the colorectal cancer liver metastases, and the action mechanisms and dose-limiting toxicities of three chemotherapy drugs are different, which makes the combination of three drugs have theoretical basis. Currently, a number of in vitro drug sensitivity tests have confirmed that these three drugs have synergistic effect between each other, for example, oxaliplatin and irinotecan active metabolite SN-38 could synergistically inhibit human HT29 colon cancer cell lines. Oxaliplatin and fluorouracil could synergistically inhibit human LoVo colon cancer cell lines. SN-38 and 5-FU could synergistically inhibit varieties of human colon cancer cell lines. Falcone et al. [10] reported the random control study results of irinotecan, oxaliplatin, and FUDR’s FOLFOXIRI program and FOLFOX program, which approved that the effective rate of FOLFOXIRI group was significantly higher than that of the latter. The median survival term and median progress time were significantly longer than the latter. Therefore, FOLFOXIRI program becomes a hot spot in colorectal cancer chemotherapy study. Intervention Division, Zhongshan Hospital, used irinotecan, oxaliplatin, and FUDR as first-line or second-line program to treat 32 patients through arterial perfusion with unresectable colorectal cancer liver metastases. The total efficiency rate was 46.9 %, median survival term was 17.7 months, and it achieved good results (Fig. 18.2).

After resection of liver lesions, implementation of TAI can not only control the small undiscovered intrahepatic metastasis lesions but also prevent intrahepatic recurrence. Kermeny et al. [11] carried on a control study between the patients who received arterial perfusion chemotherapy after the operation of colorectal cancer liver metastases and the patients who do not receive the treatment. The 4-year intrahepatic recurrence free rates were 67 % and 43 %, respectively, with a significant difference. In another study, 156 patients who received the colorectal cancer liver metastasis resection were randomly divided into two groups [12]: one was given arterial administration of FUDR and intravenous administration of 5-FU and LV; the other was given intravenous administration of 5-FU And LV. Both treatment periods were six cycles. The 2-year survival rates of intravenous administration group and the artery and vein combined administration group were 72 and 86 % (P = 0.03). The two groups’ median survival term was 62.7 and 72.2 months. The death risk of the intravenous administration group was 2.34 times of the artery and vein combined administration group.

The advantages of arterial neoadjuvant treatment are as follows: (1) control and reduce intrahepatic metastasis lesions, decrease tumor stage, make the unresectable tumor resectable, improve the curative resection rate, and reduce the relapse rate; (2) control preoperatively existing small lesions and reduce the postoperative recurrence; (3) prevent postoperative changes in tumor blood supply and influence the effects of chemotherapy; (4) prevent the tumor proliferation stimulation induced by the primary tumors and control the iatrogenic transfer; (5) as a chemotherapy-sensitive test, rationally select the sensitive drug and help to determine prognosis; and (6) screen the patients who cannot receive the surgical treatment.

There are a lot of reports about radical resection of inoperable colorectal cancer after receiving intravenous chemotherapy [13], but there is still less experience in the arterial neoadjuvant therapy of the colorectal cancer liver metastases. Zelek et al. [14] treated 31 patients with unresectable liver metastases of colorectal cancer, among which 11 patients received the radical resection through the method of intravenous administration of irinotecan and 5-FU, combining with artery epirubicin.

During arterial perfusion chemotherapy and chemoembolization, the liver and gastrointestinal blood concentrations are significantly higher than peripheral blood drug concentrations. So the liver and upper gastrointestinal local adverse reactions are obvious. The incidence rates of the bone marrow suppression, alopecia, diarrhea, and other systemic adverse reactions are lower than those in the intravenous chemotherapy. In addition to chemotherapy drug adverse reactions, the common complications are as follows: