Background
Heated intraperitoneal chemotherapy (HIPEC) treats residual microscopic disease after
cytoreductive surgery. In experimental models, the open HIPEC technique has shown
a higher and more homogenous concentration of platinum in the peritoneum than achieved
using the closed technique. A 25-cm H2O pressure enhances the penetration of oxaliplatin. Because pressure is easier to
set up with the closed technique, high pressure may counterbalance the drawbacks of
this technique versus open HIPEC, and a higher pressure may induce a higher penetration.
Because higher concentration does not mean deeper penetration, a study of tissues
beneath the peritoneum is required. Finally, achieving a deeper penetration (and a
higher concentration) raises the question of the passage of drugs through the surgical
glove and the surgeon's safety.
Methods
Four groups of pigs underwent HIPEC with oxaliplatin (150 mg/L) for 30 minutes in
open isobaric pressure and pressure at 25 cm H2O, and closed pressure at 25 and 40 cm H2O. Systemic absorption and peritoneal mapping of the concentration of platinum were
analyzed, as well as in the retroperitoneal tissue and the surgical gloves.
Results
Blood concentrations were higher in open groups. In the parietal surfaces, the concentrations
were not different between the isobaric and the closed groups (47.08, 56.39, and 48.57 mg/kg,
respectively), but were higher in the open high-pressure group (85.93 mg/kg). In the
visceral surfaces, they were lower in the closed groups (3.2 and 3.05 mg/kg) than
in the open groups (7.03 and 9.56 mg/kg). Platinum concentrations were similar in
the deep retroperitoneal tissue when compared between isobaric and high-pressure procedures.
No platin was detected in the internal aspect of the gloves.
Conclusion
The use of high pressure during HIPEC does not counterbalance the drawbacks of closed
techniques. The tissue concentration of oxaliplatin achieved with the open techniques
is higher, even if high pressure is applied during a closed technique. Open 25 cm
H2O HIPEC achieved the highest tissue penetration of oxaliplatin, but did not enhance
the depth of oxaliplatin penetration. High pressure did not enhance the risk of HIPEC.
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Article info
Publication history
Published online: July 12, 2014
Accepted:
June 9,
2014
Footnotes
Conflict of interest statement: This work was supported by research grants from the French National League against Cancer (comité Grand Est) 2011 and from the University Hospital of Dijon – Regional Council of Burgundy (France). Oxaliplatin was provided free of charge by Mylan SAS, France. There are no other commercial sponsorships or conflicts of interest to declare.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
