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01-07-2020 | Cytostatic Therapy

Pressurized intraperitoneal aerosol chemotherapy (PIPAC) might increase the risk of anastomotic leakage compared to HIPEC: an experimental study

Authors: Clément Tavernier, Guillaume Passot, Oliva Vassal, Bernard Allaouchiche, Evelyne Decullier, Naoual Bakrin, Mohammad Alyami, Axel Davigo, Jeanne-Marie Bonnet, Vanessa Louzier, Christian Paquet, Olivier Glehen, Vahan Kepenekian

Published in: Surgical Endoscopy | Issue 7/2020

Abstract

Background

Pressurized intraperitoneal aerosol chemotherapy (PIPAC) and hyperthermic intraperitoneal chemotherapy (HIPEC) are technics proposed to treat patients with peritoneal carcinomatosis, in different settings. There is some concern about an over-risk of anastomotic leakage (AL) with PIPAC jeopardizing a combination with cytoreductive surgery. This study used a healthy swine model to compare the postoperative AL rate between PIPAC and HIPEC with digestive resection and to analyze macrocirculation and microcirculation parameters.

Methods

Segmental colonic resection with a handsewn anastomosis was performed on 16 healthy pigs; 8 pigs had a PIPAC procedure with 7.5 mg/m² cisplatin (PIPAC group), and 8 pigs had a closed HIPEC procedure with 70 mg/m² cisplatin and 42 °C as the target intraperitoneal temperature (HIPEC group). Pigs were kept alive for 8 days, then sacrificed and autopsied to look for AL, which was defined as local abscess or digestive fluid leakage when pressure was applied to the anastomosis. Food intake, weight, and core temperature were monitored postoperatively. Macrocirculation (heart rate, systolic blood pressure) and microcirculation parameters (percentage of perfused vessels, perfused vessels density, DeBacker score) were evaluated intraoperatively at five timepoints. Results were compared between pigs with AL and those without.

Results

The HIPEC group had no AL, but 3 of 8 pigs (37.5%) had AL in the PIPAC group (p = 0.20). Heart rate and core temperature showed perioperative increases in the HIPEC group. Intraoperatively, heart rate was higher in the HIPEC group at the two last timepoints (123 vs. 93 bpm, p = 0.031, and 110 vs. 85 bpm, p = 0.010, at timepoints 3 and 4, respectively). Other macrocirculatory and microcirculatory parameters showed no significant differences.

Conclusion

In this healthy swine model, PIPAC might have increased AL incidence compared to HIPEC. This potential over-risk did not seem to be related to changes in the microcirculation. PIPAC should probably not be used with digestive resection and should be avoided in cases of perioperative serosal injury.

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Title: Pressurized intraperitoneal aerosol chemotherapy (PIPAC) might increase the risk of anastomotic leakage compared to HIPEC: an experimental study
Authors: Clément Tavernier
Guillaume Passot
Oliva Vassal
Bernard Allaouchiche
Evelyne Decullier
Naoual Bakrin
Mohammad Alyami
Axel Davigo
Jeanne-Marie Bonnet
Vanessa Louzier
Christian Paquet
Olivier Glehen
Vahan Kepenekian
Publication date: 01-07-2020
Publisher: Springer US
Keyword: Cytostatic Therapy
Published in: Surgical Endoscopy / Issue 7/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-019-07076-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Pressurized intraperitoneal aerosol chemotherapy (PIPAC) might increase the risk of anastomotic leakage compared to HIPEC: an experimental study

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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