Concierge HPB oncology · UK
Hepatic artery infusion pump therapy, for liver-limited disease.
A surgically implanted pump that delivers chemotherapy — usually floxuridine — directly into the hepatic artery. Rare in the UK, MDT-gated, and only right for a specific kind of patient. We help you find out whether you are one of them.
Why patients choose us
- 01
An HPB surgeon and an oncologist, together
Not a single-clinician decision. A named HPB surgeon, medical oncologist and interventional radiologist review your scans before anyone quotes a pump.
- 02
The UK centres that actually do this
HAI pumps are still rare in the UK. We know which handful of centres — Nottingham, Manchester, Liverpool and select London units — run active programmes.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What HAI pump therapy costs privately in the UK.
Indicative ranges across the small number of UK centres that offer HAI. NHS access, where available, is via specialised commissioning or an individual funding request.
In short
Pump implantation in our network: £30,000–£50,000, then £2,500–£4,500 per cycle.
| Item | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| MDT review and treatment plan | £600–£1,200 | 1–2 weeks | Written plan |
| Pre-op imaging (CT + PET-CT + MRI liver) | £2,500–£4,500 | Same week | 48–72 hrs |
| HAI pump implantation (surgery + admission) | £30,000–£50,000 | 3–5 day stay | Same admission |
| Robotic HAI insertion (where offered) | £35,000–£55,000 | 3–5 day stay | Same admission |
| Tc-MAA perfusion scan | £800–£1,400 | Same day | Same admission |
| FUDR chemotherapy per cycle | £2,500–£4,500 | 2-week cycle | Fortnightly |
| Pump refill and clinic review | £350–£600 | 30 min | Fortnightly |
| Consultation only | £300–£600 | 45 min | Same visit |
Prices vary by centre, by whether the implantation is open or robotic, by length of admission, and by which systemic chemotherapy is being given in parallel. We come back with a firm quote once the MDT has agreed the plan.
The problem
The right MDT, the right centre, the right intent.
HAI is one of the least understood cancer treatments in the UK. Patients hear about it from Memorial Sloan Kettering; the UK provision is a handful of centres. We help you work out whether HAI fits your disease before you travel.
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Not sure it is right for you?
HAI only helps if the disease is liver-limited or liver-dominant. Extra-hepatic disease usually rules it out. The MDT is direct about that.
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Confused by the alternatives?
SIRT, TACE, TARE and HAI all use the hepatic artery, but they are not interchangeable. We spell out which fits.
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Want to know if a UK centre can do it?
Nottingham, Manchester, Liverpool and a small number of London units run active programmes — we know who is currently taking referrals.
The journey
From scan review to long-term follow-up — what happens, in order.
One coordinator from first enquiry to the twelfth cycle — including the fortnightly refill logistics.
Phase 1 · Before implantation
MDT and pre-op workup
Phase 2 · Admission
Surgery and perfusion check
Phase 3 · After
Chemotherapy and follow-up
- 01
Before
You send us the scans and the story
A short, confidential form. Primary diagnosis, previous chemo lines, most recent CT/MRI and PET-CT, current bloods. If the disease is not liver-limited, we say so early.
- 02
Before
MDT review — HPB, onc, IR, hepatology
Within one working week: the MDT decides whether HAI is a fit, whether downstaging or adjuvant intent applies, and which centre is best placed to do the case.
- 03
Before
We arrange the pre-op workup
Restaging CT chest/abdo/pelvis and PET-CT if not recent, MRI liver with hepatocyte-specific contrast, LFTs and performance-status review. Anaesthetic pre-assessment.
- 04
Admission
Pump implantation in theatre
Laparotomy or robotic HAI insertion by an HPB surgeon. Cholecystectomy, catheter into the gastroduodenal artery, subcutaneous pump pocket in the LIF or RIF.
- 05
Admission
Same-admission perfusion check
A technetium macroaggregated albumin (Tc-MAA) scan through the pump confirms hepatic-only perfusion. Extra-hepatic uptake is picked up here, not after chemo has started.
- 06
After
Recovery, then FUDR starts
Discharge at day 3–5 once the wound is clean and the perfusion scan is clear. FUDR 0.16 mg/kg/day is loaded into the pump on a 14-days-on, 14-days-off cycle, usually alongside systemic FOLFOX.
- 07
After
Cycles, restaging and long-term follow-up
6–12 cycles typical, with restaging CT every 2–3 cycles. LFTs and bilirubin watched closely for biliary sclerosis. Pump refills every 2 weeks at the treating centre.
Typical MDT-to-theatre: 3–5 weeks. Full course: 6–12 cycles over 6–12 months.
When it helps
When HAI is the right step — and when it isn’t.
The classical HAI indications, the eligibility gates, and the one red flag that makes HAI the wrong tool.
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Unresectable liver-limited CRLM
Colorectal liver metastases that cannot be resected, with no significant extra-hepatic disease on CT and PET-CT.
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Downstaging to resection
Liver-only disease where 6–12 cycles of HAI plus systemic chemo may shrink tumours enough to allow curative resection — achieved in roughly a fifth to a third of carefully selected patients.
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Adjuvant after CRLM resection
After liver resection for CRLM, HAI plus systemic chemo can lower the rate of new hepatic recurrence — the Kemeny NEJM data, with modern updates.
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Unresectable intrahepatic cholangiocarcinoma
Liver-confined ICC after gemcitabine/cisplatin, based on the Memorial Sloan Kettering and Manchester experience.
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Progression on first-line systemic chemo
Liver-dominant progression on FOLFOX/FOLFIRI ± bevacizumab, with the rest of the disease under control — a common HAI referral.
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Preserved liver function and performance
Bilirubin near-normal, ECOG 0–1, fit for laparotomy or robotic surgery. Poor performance status is a firm contraindication.
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Willing to commit to fortnightly refills
FUDR is loaded into the pump every two weeks at the treating centre. Distance from Nottingham, Manchester or Liverpool is a practical question.
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Red flag: extra-hepatic disease
Meaningful disease outside the liver — peritoneum, nodes beyond the porta, lung — makes HAI the wrong tool. Systemic control comes first.
Procedure options
One pump, several intents — and several access routes.
What each version of HAI actually involves — palliative, conversion, adjuvant — and how the NHS and private routes compare.
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Open HAI pump insertion
The classical laparotomy approach, still the standard in most UK centres. Best control of the arterial anatomy in complex cases.
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Robotic HAI insertion
Available in a small number of UK units. Shorter recovery in the right patient, but not always feasible with variant arterial anatomy.
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HAI for CRLM — palliative intent
For unresectable liver-limited disease where downstaging is unlikely — aims for durable liver control and extended survival.
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HAI for CRLM — conversion intent
Given specifically to shrink tumours to a resectable state, with a planned re-look and hepatectomy after 6–12 cycles.
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HAI adjuvant after resection
Started 4–8 weeks after CRLM resection to reduce hepatic recurrence, always combined with systemic chemo.
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HAI for intrahepatic cholangiocarcinoma
Second-line option after gemcitabine/cisplatin in patients whose disease stays liver-confined.
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NHS route (specialised commissioning / IFR)
HAI sits inside a specific NHS England specialised commissioning pathway; access outside listed centres usually needs an individual funding request.
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Consultation only
An honest MDT view on whether HAI is the right step, whether a trial is open to you, and what your alternatives really are.
Our vetted UK network
A handful of centres, we picked them.
HPB units in Nottingham, Manchester, Liverpool and select London hospitals with active HAI programmes. Introductions are made privately, once the MDT has agreed the plan.
Selection criteria
How we choose every HAI centre in our network.
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HPB surgeons who run an active HAI programme, not occasional implanters
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Medical oncologists experienced with FUDR dosing and biliary-toxicity monitoring
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Interventional radiology on hand for catheter troubleshooting and Tc-MAA perfusion checks
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MDT that will say no when HAI is not the right tool — extra-hepatic disease, poor performance status, or unfit liver function
Safety and side effects
What to expect — honestly.
HAI is a serious intervention. Systemic toxicity is much less than IV chemotherapy, but the liver-directed side effects — biliary sclerosis in particular — need close monitoring.
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Biliary sclerosis is the dose-limiting toxicity
FUDR can cause peri-ductal fibrosis — a stricturing cholangitis picked up on rising bilirubin and MRCP. Dose reductions, holidays and dexamethasone add-back all help; missing it costs the liver.
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Gastroduodenal ulceration if perfusion leaks
FUDR reaching the stomach or duodenum through a mis-directed catheter causes deep ulcers. The Tc-MAA scan and careful GDA dissection at surgery are how this is prevented, not treated.
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Pump-pocket problems
Haematoma, seroma or wound infection in the abdominal pocket in 5–10%. Pump extrusion is rare but real and needs revision.
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Catheter thrombosis and migration
The pump is flushed with heparin between cycles. Catheter thrombosis, dissection of the hepatic artery or catheter migration all need IR review, sometimes revision surgery.
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Chemical hepatitis and cholangiopathy
A rise in ALT/AST is common early and usually settles; a rise in bilirubin or alk phos is the one to worry about — it is the biliary tree talking.
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Much less systemic toxicity than IV chemo
The liver extracts 95%+ of FUDR on first pass, so myelosuppression, mucositis and neuropathy are markedly less than with systemic 5-FU regimens.
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Variant hepatic anatomy matters
A replaced or accessory right hepatic artery from the SMA is present in 15–20% and must be ligated at surgery, or perfusion is incomplete.
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Not the same as SIRT, TACE or TARE
Y-90 radioembolisation and TACE are one-off interventional radiology treatments through the hepatic artery. HAI is continuous chemotherapy through a surgically implanted pump — different mechanism, different toxicity, different candidates.
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Red flags after implantation
Fever, jaundice, epigastric pain, coffee-ground vomiting or a hot swollen pump pocket are all reasons to contact the treating centre the same day.
Reading your operation note
Your operation note in four parts. Read the last one first.
However the pump was implanted, the note the HPB surgeon and oncologist send you keeps to the same shape.
A quiet reminder
Surgical and oncology language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Diagnosis, intent and MDT decision
Primary tumour, extent of liver disease, whether the intent is palliative, conversion or adjuvant, and the MDT record that agreed the plan.
- 02 Technique
Surgical technique and arterial anatomy
Open or robotic, cholecystectomy, GDA catheter position, any variant right hepatic artery ligated, and the exact pump model and pocket site.
- 03 Findings
Tc-MAA perfusion and post-op imaging
The perfusion scan result — hepatic-only or with extra-hepatic uptake, plus any relevant post-op CT findings and bloods.
- 04 Impression
Chemo plan, refill schedule and monitoring
Read this first: FUDR dose, cycle plan, systemic chemo partner, refill schedule, LFT monitoring and when the next restaging CT is due.
Recognised by major UK insurers
Cover for HAI varies by insurer and by indication — some fund the implantation and cycles as part of oncology cover, others require pre-authorisation on a case-by-case basis. We confirm cover before booking.
Frequently asked
Everything we get asked about HAI.
Quick answers on eligibility, cost, side effects, and how HAI compares with SIRT, TACE and TARE.
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What is a hepatic artery infusion pump?
A subcutaneous pump — about the size of a hockey puck — surgically implanted under the skin of the abdomen, connected by a catheter into the gastroduodenal artery so that chemotherapy (usually floxuridine, FUDR) is delivered directly into the hepatic artery. Because the liver extracts most of the drug on the first pass, tumours get 100–400 times more drug than they would from an IV, while the rest of the body is largely spared.
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Who is a candidate for HAI in the UK?
Patients with unresectable but liver-limited colorectal liver metastases, patients being considered for downstaging to resection, selected patients after CRLM resection (adjuvant), and selected patients with unresectable intrahepatic cholangiocarcinoma. Extra-hepatic disease, poor performance status and impaired liver function are the main exclusions.
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How available is HAI in the UK?
Very limited. HAI has been championed for decades at Memorial Sloan Kettering in New York; UK provision is expanding through a small number of centres — Nottingham, Manchester, Liverpool and a handful of London units — via trials, private pathways and individual funding requests. This is why an experienced MDT view matters before you commit.
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How much does an HAI pump cost privately in the UK?
Roughly £30,000–£50,000 for the surgery and initial admission, plus £2,500–£4,500 per FUDR cycle and £350–£600 per fortnightly refill. Pre-op imaging and MDT review add £3,000–£6,000. We come back with a firm written quote once the MDT has agreed the plan.
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What are the main side effects of HAI chemotherapy?
The dose-limiting problem is biliary sclerosis — a stricturing cholangitis from FUDR damaging the bile ducts, picked up on rising bilirubin. Gastroduodenal ulceration can happen if any drug leaks outside the liver. Pump-pocket problems, catheter thrombosis and chemical hepatitis are the other big ones. Systemic side effects (nausea, low counts) are much less than IV chemotherapy.
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How is HAI different from SIRT, TACE or TARE?
SIRT/TARE (Y-90 radioembolisation) and TACE (transarterial chemoembolisation) are one-off interventional radiology treatments delivered by catheter through the hepatic artery — no implanted pump, no continuous chemotherapy. HAI is continuous cytotoxic chemotherapy given through a surgically implanted pump over months. Different mechanism, different toxicity, different candidates — the MDT will say which, if any, is right for you.
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Can HAI shrink my tumours enough for surgery?
In carefully selected patients with liver-limited unresectable CRLM, HAI plus systemic chemotherapy converts roughly 20–30% of patients to a resectable state. If that happens, subsequent hepatectomy carries a real prospect of long-term survival — five-year survival around 40% in the published series.
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What does the day-to-day look like once the pump is in?
The pump lives under the skin — you can feel it but it does not restrict day-to-day activity. Every two weeks you attend the treating centre for a refill, a set of bloods, and a short clinic review. Restaging CT every 2–3 cycles. Most patients continue to work through treatment.
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