Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Clinical and Translational Oncology
Published in: Clinical and Translational Oncology 9/2019

01-09-2019 | Peritoneal Cancer | Research Article

Laparoscopic cytoreductive surgery and HIPEC is effective regarding peritoneum tissue paclitaxel distribution

Authors: D. Padilla-Valverde, P. Villarejo, J. Redondo, J. Oyarzabal, A. Estella, T. Palomino, E. Fernandez, S. Sanchez, S. Sánchez, P. Faba, V. Baladron, A. Alberca, O. Montenegro, J. Fernández, P. Marta, J. Martín

Published in: Clinical and Translational Oncology | Issue 9/2019

Login to get access

Abstract

Background

In some patients with peritoneal carcinomatosis, we could perform the cytoreductive surgery and the HIPEC procedure by a complete laparoscopic approach to avoid morbidity. We consider that using laparoscopic approach for performing peritoneal carcinomatosis cytoreductive surgery and HIPEC with closed CO2 recirculation technique is possible and safe, with equal efficacy to conventional methods and hemodynamic complications.

Objective

Monitoring the effectiveness of the drug distribution in a laparoscopic ctoreductive and HIPEC surgery group with CO2 recirculation respect to a closed and open HIPEC group

Methods

Porcine model that included fifteen mini-pigs. Five pigs were operated with laparoscopic approach performing a pelvic and retroperitoneal lymphadenectomy. They later received a total laparoscopic closed HIPEC with CO2 recirculation (G1). Group 2 (G2): five pigs operated by an open cytoreductive surgery and closed HIPEC technique. Group 3 (G3): five animals in which an open cytoreductive surgery and an open HIPEC technique was performed. Blood and peritoneal determinations were realized after recirculation of the drug, at 60 min using chromatographic analysis.

Results

G1–G2: phrenic right peritoneum, p: 0.46. Phrenic left peritoneum, p: 0.46. Pelvic peritoneum, p: 0.17. Serum paclitaxel: p: 0.01. G1–G3: phrenic right peritoneum, p: 0.34. Phrenic left peritoneum, p: 0.34. Pelvic peritoneum, p: 0.17. Serum paclitaxel G1–G3, p: 0.02.

Conclusions

A total laparoscopic approach for ctoreductive surgery and closed HIPEC with CO2 recirculation may be safe and feasible. In our experimental model there was no significant difference in tissue drug distribution respect the conventional techniques and there was a less toxicity because the serum drug concentration was significantly lower with laparoscopic approach respect the other groups.
Literature
1.
Pelz JO, Vetterlein M, Grimmig T, Grimmiq T, Kerscher AG, Moll E, et al. Hyperthermic intraperitoneal chemotherapy in patients with peritoneal carcinomatosis: role of heat shock proteins and dissecting effects of hyperthermia. Ann Surg Oncol. 2013;20:1105–13.CrossRefPubMed
2.
Dudar TE, Jain RK. Differential response of normal and tumor microcirculation to hyperthermia. Cancer Res. 1984;44:605–12.PubMed
3.
Overgaard J. Effect of hyperthermia on malignant cells in vivo: a review and a hypothesis. Cancer. 1977;39:2637–46.CrossRefPubMed
4.
Hildebrandt B, Wust P, Ahlers O, Dieing A, Screenivasa G, Kerner T, Felix R, Riess H. The cellular and molecular basis of hyperthermia. Crit Rev Oncol Hematol. 2002;43:33–56.CrossRefPubMed
5.
El-Kareh AW, Secomb TW. A theoretical model for intraperitoneal delivery of cisplatin and the effect of hyperthermia on drug penetration distance. Neoplasia. 2004;6:117–27.CrossRefPubMedPubMedCentral
6.
Konigsrainer I, Beckert S. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: where are we? World J Gastroenterol. 2012;18:5317–20.CrossRefPubMedPubMedCentral
7.
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;15(98):242–6.CrossRef
8.
Bijelic L, Jonson A, Sugarbaker PH. Systematic review of cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy for treatment of peritoneal carcinomatosis in primary and recurrent ovarian cancer. Ann Oncol. 2007;18:1943–50.CrossRefPubMed
9.
Stephens AD, Alderman R, Chang D, Edwards GD, Esquivel J, Sebbaq 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;6:790–6.CrossRefPubMed
10.
Gesson-Paute A, Ferron G, Thomas F, de Lara EC, Chatelut E, Querleu D. Pharmacokinetics of oxaliplatin during open versus laparoscopically assisted heated intraoperative intraperitoneal chemotherapy (HIPEC): an experimental study. Ann Surg Oncol. 2008;15:339–44.CrossRefPubMed
11.
Sugarbaker PH. Management of peritoneal-surface malignancy: the surgeon‘s role. Langenbecks Arch Surg. 1999;384:576–87.CrossRefPubMed
12.
Simon L, Halilou MC, 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;96:971–7.CrossRef
13.
Sugarbaker PH. An Instrument to provide containment of intraoperative intraperitoneal chemotherapy with optimized distribution. J Surg Oncol. 2005;92:142–6.CrossRefPubMed
14.
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;10:863–9.CrossRefPubMed
15.
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;106:1144–53.CrossRefPubMed
16.
Ortega-Deballon P, Facy O, Jambet S, Magnin G, Cotte E, Beltramo JL, et al. Which method to deliver hyperthermic intraperitoneal chemotherapy with oxaliplatin? An experimental comparison of open and closed techniques. Ann Surg Oncol. 2010;17:1957–63.CrossRefPubMed
17.
Raspe C, Piso P, Wiesenack C, Bucher M. Anesthetic management in patients undergoing hyperthermic chemotherapy. Curr Opin Anesthesiol. 2012;25:348–55.CrossRef
18.
Eichhorn V, Goepfert MS, Eulenburg C, Malbrain ML, Reuter DA. Comparison of values in critically ill patients for global end-diastolic volume and extravascular lung water measured by transcardiopulmonary thermodilution: a meta-analysis of the literature. Med Intensiva. 2012;36:467–74.CrossRefPubMed
19.
Huber W, Umgelter A, Reindl W, Franzen M, Schmidt C, von Delius S, et al. Volume assessment in patients with necrotizing pancreatitis: a comparison of intrathoracic blood volumen index, central venous pressure, and hematocrit, and their correlation to cardiac index and extravascular lung water. Crit Care Med. 2008;36:2348–54.CrossRefPubMed
20.
Costa MG, Chiarandini P, Rocca D. Hemodynamics during liver transplantation. Transplant Proc. 2007;39:1871–3.CrossRefPubMed
21.
Della Rocca G, Costa MG, Pompei G, Coccia C, Pitropaoli P. Continuous and intermittent cardiac output measurement: pulmonary artery catheter versus aortic transpulmonary technique. Br J Anaesth. 2002;88:350–6.CrossRefPubMed
22.
Feltracco P, Biancofiore G, Ori C, Saner FH, Della Rocca G. Limits and pitfalls of haemodynamic monitoring systems in liver transplantation surgery. Minerva Anastesiol. 2012;78:1372–84.
23.
Rothfield KP, Crowley K. Anesthesia considerations during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Surg Oncol Clin N Am. 2012;21:533–41.CrossRefPubMed
24.
Facchiano E, Risio D, Kianmanesh R, Msika S. Laparoscopic hyperthermic intraperitoneal chemotherapy: indications, aims and results. A systematic review of the literature. Ann Surg Oncol. 2012;19:2946–50.CrossRef
25.
Sloothaak DAM, Gardenbroek TJ, Crezee J, Bemelman WA, Punt CJ, Buskens CJ, et al. Feasibility of adjuvant laparoscopic hyperthermic intraperitoneal chemotherapy in a short stay setting in patients with colorectal cancer at high risk of peritoneal carcinomatosis. EJSO. 2014;40:1453–8.CrossRefPubMed
26.
Esquivel J, Averbach A, Chua TC. Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with limited peritoneal surfaces malignancies. Ann Surg. 2011;253:764–8.CrossRef
27.
Lotti M, Capponi MG, Piazzalunga D, Poiasina E, Pisano M, Manfredi R, et al. Laparoscopic HIPEC: a bridge between open and closed techniques. J Minim Acces Surg. 2016;12:86–9.CrossRef
28.
Sánchez García S, Padilla Valverde D, Villarejo Campos P, Martin-Fernandez J, Garcia-Rojo M, Rodriguez-Martinez M. Experimental development of an intra-abdominal chemohyperthermia model using a closed abdomen technique and a PRS-1.0 Combat® CO2 recirculation system. Surgery. 2014;155(4):719–25.CrossRefPubMed
29.
Sánchez García S, Villarejo Campos P, Padilla Valverde D, Amo-Salas M, Martin-Fernandez J. Intraperitoneal chemotherapy hyperthermia (HIPEC) for peritoneal carcinomatosis of ovarian cancer origin by fluid and CO2 recirculation using the closed-abdomen technique (Combat PRS-1.0): a clinical pilot study. Int J Hyperth. 2016;32(5):488–98.CrossRef
30.
Padilla-Valverde D, Sanchez-Garcia S, García-Santos E, Marcote-Ibañez C, Molina-Robles M, Martin-fernandez J, et al. Usefulness of thermographic analysis to control temperature homogeneity in the development and implementation of a closed recirculating CO2 chemohyperthermia model. Int J Hyperth. 2016;30:1–7.
31.
García-Santos EP, Padilla-Valverde D, Villarejo-Campos P, Murillo-Lazaro C, Fernandez-grande E, Palomino-Muñoz T, et al. The utility of hyperthermic intra-abdominal chemotherapy with gemcitabine for the inhibition of tumor progression in an experimental model of pancreatic peritoneal carcinomatosis, in relation to their behavior with pancreatic cancer stem cells CD133+ CXCR10. Pancreatology. 2016;16(4):632–9.CrossRefPubMed
32.
Pascual-Ramírez J, Sánchez-García S, González-Ruizdelaherrán F, Villarejo-Campos P, LopezdelaManzanara C, Haya-Palazuelo J, et al. Security and efficiency of a closed-system, turbulent-flow circuit for hyperthermic intraperitoneal chemotherapy after cytoreductive ovarian surgery: perioperative outputs. Arch Gynecol Obstet. 2014;290:121–9.CrossRefPubMed
33.
Sanchez-García S, Padilla-Valverde D, Villarejo-Campos P, Garcia-santos E, Martin-Fernandez J. Hyperthermic chemotherapy intra-abdominal laparoscopic approach: development of a laparoscopic model using CO2 recirculation system and clinical translation in peritoneal carcinomatosis. Int J Hyperth. 2017;33:684–9.CrossRef
34.
Facy O, Al Samman S, Magnin G, Ghiringhelli F, Ladoire S, Chauffert B, et al. High pressure enhances the effect of hyperthermia in intraperitoneal chemotherapy with oxaliplatin: an experimental study. Ann Surg. 2012;256:1084–8.CrossRefPubMed
35.
Klaver YL, Hendriks T, Lomme RM, Rutten HJ, Bleichrodt RP, de Hingh IH. Hyperthermia and intraperitoneal chemotherapy for the treatment of peritoneal carcinomatosis: an experimental study. Ann Surg. 2011;254:125–30.CrossRefPubMed
36.
Piche N, Leblond FA, Sidéris L, Pichette V, Drolet P, Fotier LP, et al. Rationale for heating oxaliplatin for the intraperitoneal treatment of peritoneal carcinomatosis. A study of the effect of heat on intraperitoneal oxaliplatin using a murine model. Ann Surg. 2011;254:138–44.CrossRefPubMed
37.
Esquis P, Consolo D, Margin D, Pointaire P, Moretto P, Ynsa MD, et al. High intrabdominal pressure enhances the penetration and antitumor effect of intraperitoneal cisplatin on experimental peritoneal carcinomatosis. Ann Surg. 2006;244:106–12.CrossRefPubMedPubMedCentral
Metadata
Title
Laparoscopic cytoreductive surgery and HIPEC is effective regarding peritoneum tissue paclitaxel distribution
Authors
D. Padilla-Valverde
P. Villarejo
J. Redondo
J. Oyarzabal
A. Estella
T. Palomino
E. Fernandez
S. Sanchez
S. Sánchez
P. Faba
V. Baladron
A. Alberca
O. Montenegro
J. Fernández
P. Marta
J. Martín
Publication date
01-09-2019
Publisher
Springer International Publishing
Published in
Clinical and Translational Oncology / Issue 9/2019
Print ISSN: 1699-048X
Electronic ISSN: 1699-3055
DOI
https://doi.org/10.1007/s12094-019-02052-8

Other articles of this Issue 9/2019

Clinical and Translational Oncology 9/2019 Go to the issue

Research Article

Current management of breakthrough cancer pain according to physicians from pain units in Spain

Research Article

Efficacy of nintedanib and docetaxel in patients with advanced lung adenocarcinoma treated with first-line chemotherapy and second-line immunotherapy in the nintedanib NPU program

Research Article

The incidence proportion of erectile dysfunction in patients treated with cryotherapy for prostate cancer: a meta-analysis

Research Article

Cardiovascular disease and survival in non-small cell lung cancer: a multicenter prospective assessment

Brief Research Article

Blockage of autophagic flux is associated with lymphocytosis and higher percentage of tumoral cells in chronic lymphocytic leukemia of B cells

Research Article

Nodal FDG-PET/CT uptake influences outcome and relapse location among esophageal cancer patients submitted to chemotherapy or radiochemotherapy
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits