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Experimental development of an intra-abdominal chemohyperthermia model using a closed abdomen technique and a PRS-1.0 Combat CO2 recirculation system

Published:December 16, 2013DOI:https://doi.org/10.1016/j.surg.2013.12.005

      Background

      Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is the best operative treatment currently available for patients with peritoneal carcinomatosis of ovarian origin. The open abdomen technique is the classic technique for hyperthermic intraperitoneal chemotherapy. We developed a closed abdomen model that improves temperature control and increases exposure of peritoneal surfaces to the drug by recirculating the perfusate.

      Methods

      We used a porcine model with 12 female, Large White pigs—4 in the open technique group and 8 in the closed technique CO2 group. We performed cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for 60 minutes using paclitaxel (175 mg/m2) at an input temperature of 42°C. Perfusate recirculation was performed under controlled pressure (range, 12–15 mmHg). The infusion of 0.7 L of CO2 via a separate intraperitoneal infusion catheter mixed the perfusate within the peritoneal cavity. Intra-abdominal temperature was assessed using 6 intra-abdominal temperature probes and 2 temperature probes in the inflow and outflow circuits. Drug distribution was assessed using methylene blue staining.

      Results

      Intra-abdominal temperatures remained constant and homogeneous in all intra-abdominal quadrants with a constant input temperature of 42°C and a minimum output temperature of 41.4°C. The infused CO2 caused the fluid to bubble and created agitation inside the abdominal cavity to facilitate a homogeneous distribution of the drug-containing perfusate.

      Conclusion

      The closed recirculation hyperthermia with intraperitoneal chemotherapy technique developed in this study is safe and feasible, and may provide a more homogeneous delivery of heated chemotherapy to the peritoneal cavity in patients with peritoneal malignancies.
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      References

        • Jaaback K.
        • Johnson N.
        • Lawrie T.A.
        Intraperitoneal chemotherapy for the initial management of primary epithelial ovarian cancer.
        Cochrane Database Syst Rev. 2011; : CD005340
        • Pelz J.O.
        • Vetterlein M.
        • Grimmig T.
        • Kerscher A.G.
        • Moll E.
        • Lazariotou M.
        • et al.
        Hyperthermic intraperitoneal chemotherapy in patients with peritoneal carcinomatosis: role of heat shock proteins and dissecting effects of hyperthermia.
        Ann Surg Oncol. 2013; 20: 1105-1113
        • Dudar T.E.
        • Jain R.K.
        Differential response of normal and tumor microcirculation to hyperthermia.
        Cancer Res. 1984; 44: 605-612
        • Overgaard J.
        Effect of hyperthermia on malignant cells in vivo. A review and a hypothesis.
        Cancer. 1977; 39: 2637-2646
        • Hildebrandt B.
        • Wust P.
        • Ahlers O.
        • Dieing A.
        • Sreenivasa G.
        • Kerner T.
        • et al.
        The cellular and molecular basis of hyperthermia.
        Crit Rev Oncol Hematol. 2002; 43: 33-56
        • El-Kareh A.W.
        • Secomb T.W.
        A theoretical model for intraperitoneal delivery of cisplatin and the effect of hyperthermia on drug penetration distance.
        Neoplasia. 2004; 6: 117-127
        • Elias D.
        • Detroz B.
        • Debaene B.
        • Damia E.
        • Leclercq B.
        • Rougier P.
        • et al.
        Treatment of peritoneal carcinomatosis by intraperitoneal chemo-hyperthermia: reliable and unreliable concepts.
        Hepatogastroenterology. 1994; 41: 207-213
        • Konigsrainer I.
        • Beckert S.
        Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: where are we?.
        World J Gastroenterol. 2012; 18: 5317-5320
        • Glehen O.
        • Cotte E.
        • Kusamura S.
        • Deraco M.
        • Baratti D.
        • Passot G.
        • et al.
        Hyperthermic intraperitoneal chemotherapy: nomenclature and modalities of perfusion.
        J Surg Oncol. 2008; 98: 242-246
        • Bijelic L.
        • Jonson A.
        • Sugarbaker P.H.
        Systematic review of cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy for treatment of peritoneal carcinomatosis in primary and recurrent ovarian cancer.
        Ann Oncol. 2007; 18: 1943-1950
        • Stephens A.D.
        • Alderman R.
        • Chang D.
        • Edwards G.D.
        • Esquivel J.
        • Sebbag G.
        • et al.
        Morbidity and mortality analysis of 200 treatments with cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy using the coliseum technique.
        Ann Surg Oncol. 1999; 6: 790-796
        • Gesson-Paute A.
        • Ferron G.
        • Thomas F.
        • de Lara E.C.
        • Chatelut E.
        • Querleu D.
        Pharmacokinetics of oxaliplatin during open versus laparoscopically assisted heated intraoperative intraperitoneal chemotherapy (HIPEC): an experimental study.
        Ann Surg Oncol. 2008; 15: 339-344
        • Sugarbaker P.H.
        Management of peritoneal-surface malignancy: the surgeon's role.
        Langenbecks Arch Surg. 1999; 384: 576-587
        • Elias D.
        • Antoun S.
        • Goharin A.
        • Otmany A.E.
        • Puizillout J.M.
        • Lasser P.
        Research on the best chemohyperthermia technique of treatment of peritoneal carcinomatosis after complete resection.
        Int J Surg Investig. 2000; 1: 431-439
        • Gonzalez-Moreno S.
        • Gonzalez-Bayon L.A.
        • Ortega-Perez G.
        Hyperthermic intraperitoneal chemotherapy: rationale and technique.
        World J Gastrointest Oncol. 2010; 2: 68-75
        • Simon L.
        • Halilou M.C.
        • Gladieff L.
        • Gadiou M.
        • Herin F.
        • Hennebelle I.
        • et al.
        Hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC): evaluation, prevention and policies to avoid occupational exposure for operating room personnel.
        Bull Cancer. 2009; 96: 971-977
        • Sugarbaker P.H.
        An instrument to provide containment of intraoperative intraperitoneal chemotherapy with optimized distribution.
        J Surg Oncol. 2005; 92: 142-146
        • Glehen O.
        • Osinsky D.
        • Cotte E.
        • Kwiatkowski F.
        • Freyer G.
        • Isaac S.
        • et al.
        Intraperitoneal chemohyperthermia using a closed abdominal procedure and cytoreductive surgery for the treatment of peritoneal carcinomatosis: morbidity and mortality analysis of 216 consecutive procedures.
        Ann Surg Oncol. 2003; 10: 863-869
        • Kusamura S.
        • Younan R.
        • Baratti D.
        • Costanzo P.
        • Favaro M.
        • Gavazzi C.
        • et al.
        Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion: analysis of morbidity and mortality in 209 peritoneal surface malignancies treated with closed abdomen technique.
        Cancer. 2006; 106: 1144-1153
        • Glehen O.
        • Mithieux F.
        • Osinsky D.
        • Beaujard A.C.
        • Freyer G.
        • Guertsch P.
        • et al.
        Surgery combined with peritonectomy procedures and intraperitoneal chemohyperthermia in abdominal cancers with peritoneal carcinomatosis: a phase II study.
        J Clin Oncol. 2003; 21: 799-806
        • Ortega-Deballon P.
        • Facy O.
        • Jambet S.
        • Magnin G.
        • Cotte E.
        • Beltramo J.L.
        • et al.
        Which method to deliver hyperthermic intraperitoneal chemotherapy with oxaliplatin? an experimental comparison of open and closed techniques.
        Ann Surg Oncol. 2010; 17: 1957-1963
        • Ortega-Deballon P.
        • Facy O.
        • Magnin G.
        • Piard F.
        • Chauffert B.
        • Rat P.
        Using a heating cable within the abdomen to make hyperthermic intraperitoneal chemotherapy easier: feasibility and safety study in a pig model.
        Eur J Surg Oncol. 2010; 36: 324-328

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