Anaesthesia in a Toxic Environment: Pressurised Intraperitoneal Aerosol Chemotherapy: A Retrospective Analysis

Rouche, Amir; Grass, Fabian; Pache, Basile; Demartines, Nicolas; Blanc, Catherine

doi:10.5152/tjar.2019.15493

Cited by 3 publications

(3 citation statements)

References 27 publications

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“…automatic stop of the injector due to pressure limitation and minor chemotherapy leaks, entirely confined by the cover sheet systematically used. Direct incidental exposure of the OR co-workers, has not been described [ 10 ]. In a recent survey assessing safety perception of intraperitoneal chemotherapy administration (PIPAC and HIPEC) from 211 OR co-workers [ 18 ], 28% reported being aware of at least one incident, without further details.…”

Section: Discussionmentioning

confidence: 99%

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Consensus statement on safety measures for pressurized intraperitoneal aerosol chemotherapy

Girardot-Miglierina

Clerc

Alyami

et al. 2021

Pleura and Peritoneum

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Objectives Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a promising treatment for peritoneal cancer that entails, however, potential risks for the caregivers in the operating room (OR). This study aimed to reach a consensus within the PIPAC community on a comprehensive safety protocol. Methods Active PIPAC centers were invited to participate in a two-round Delphi process on 43 predefined items: concise summaries of the existing evidence were presented together with questions formulated using the population, intervention, comparator, and outcome framework. According to the Grading of Recommendations Assessment, Development, and Evaluation, the strength of recommendation was voted by panelists, accepting a consensus threshold of ≥50% of the agreement for any of the four grading options, or ≥70% in either direction. Results Forty-seven out of 66 invited panelists answered both rounds (response rate 76%). The consensus was reached for 41 out of 43 items (95.3%). Strong and weak recommendations were issued for 30 and 10 items, respectively. A positive consensual recommendation was issued to activate laminar airflow without specific strength, neither strong nor weak. No consensus was reached for systematic glove change for caregivers with a high risk of exposure and filtering facepiece mask class 3 for caregivers with low risk of exposure. Conclusions A high degree of consensus was reached for a comprehensive safety protocol for PIPAC, adapted to the risk of exposure for the different caregivers in the OR. This consensus can serve as a basis for education and help reach a high degree of adherence in daily practice.

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Section: Discussionmentioning

confidence: 99%

“…In the following years, multiple PIPAC safety audits were conducted in several European countries [ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ], [ 10 ], [ 11 ], [ 12 ]. In most audits, PIPAC was performed in OR with advanced ventilation OR system meeting the norm ISO 14644-1 class ≤5 but no laminar airflow.…”

Section: Introductionmentioning

confidence: 99%

Consensus statement on safety measures for pressurized intraperitoneal aerosol chemotherapy

Girardot-Miglierina

Clerc

Alyami

et al. 2021

Pleura and Peritoneum

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“…PIPAC was performed by use of a two-trocar technique in a strictly standardized way [ 5 , 7 ]. Cytoreductive surgery and HIPEC were performed through a midline laparotomy.…”

Section: Methodsmentioning

confidence: 99%

Histological regression of gastrointestinal peritoneal metastases after systemic chemotherapy

Toussaint

Farinha

Barras

et al. 2021

Pleura and Peritoneum

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Objectives Peritoneal metastases (PM) are relatively resistant to systemic chemotherapy, and data on histological response to therapy is rare. The aim of this study was to quantify the treatment response of PM after systemic chemotherapy. Methods Retrospective monocentric cohort study of 47 consecutive patients with PM from gastrointestinal origin undergoing surgery (cytoreduction: CRS + Hyperthermic IntraPEritoneal Chemotherapy [HIPEC] or Pressurized IntraPeritoneal Aerosol Chemotherapy [PIPAC]) after prior systemic chemotherapy from 1.2015 to 3.2019. Tumor response was assessed using the 4-scale Peritoneal Regression Grading System (PRGS) (4: vital tumor to 1: complete response). Results Patients had a median of 2 (range: 1–7) lines and 10 (3–39) cycles of prior systemic chemotherapy. A median of four biopsies (range: 3–8) was taken with a total of 196 analyzed specimens. Twenty-four biopsies (12%) showed no histological regression (PRGS4), while PRGS 3, two and one were diagnosed in 37 (19%), 39 (20%), and 69 (49%) specimens, respectively. A significant heterogeneity was found between peritoneal biopsies in 51% patients. PRGS correlated strongly with peritoneal spread (PCI, p<0.0001), and was improved in patients with more than nine cycles of systemic chemotherapy (p=0.04). Median survival was higher in patients with PRGS < 1.8 (Quartiles one and 2) than higher (Q3 and Q4), but the difference did not reach significance in this small cohort. Conclusions PRGS is an objective too to describe histological response of PM of GI origin after systemic chemotherapy. This response differs significantly between patients, allowing to distinguish between chemosensitive and chemoresistant tumors.

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Testing a Model of Care for Patients on Immune Checkpoint Inhibitors Based on Electronic Patient-Reported Outcomes: Protocol for a Randomized Phase II Controlled Trial (Preprint)

Lopes¹,

Colomer‐Lahiguera²,

Darnac³

et al. 2023

Preprint

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BACKGROUND Management of severe symptomatic immune-related adverse events (IrAEs) related to immune-checkpoint inhibitors (ICI) can be facilitated by timely detection of these complications. As patients face a heterogeneous set of symptoms outside the clinical setting, remotely monitoring and assessing symptoms using patient-reported outcomes (PRO) may result in shorter delays between symptom onset and clinician detection. OBJECTIVE This study is designed to assess the effect of a model of care based on PRO data on the time to detection of symptomatic IrAEs from symptom onset. METHODS 198 patients with cancer receiving systemic treatment comprised exclusively of ICI will be recruited from two Swiss university hospitals. Patients are randomized (1:1) to a digital model of care (intervention) or usual care (control group). Patients are enrolled for six months and use an electronic application to complete questionnaires. Patients in the intervention group complete a weekly PRO-CTCAE™ questionnaire and reassess active symptoms daily for the first three months. Nurses call patients in the event of new or worsening symptoms and manage them, using a standardized triage algorithm. Outcomes of interest include time to IrAE detection (primary outcome), time to IrAE intervention, IrAE grade (severity), health-related quality of life, self-efficacy and overall survival. RESULTS This study has received funding from the ISREC foundation and Kaiku Health Ltd. It is in active recruitment since November 2021 and is projected to conclude in November 2023. Trial results will be disseminated through publications in scientific journals, abstracts and presentations submitted at international scientific conferences. CONCLUSIONS This trial is among the first trials to use PRO data to directly influence routine care of patient treated with ICI. It aims to demonstrate the challenges of diagnosing and managing symptoms associated with treatment remotely, providing further insight into the burden they represent to patients on a daily basis. CLINICALTRIAL ClinicalTrials.gov Identifier : NCT05530187

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Anaesthesia in a Toxic Environment: Pressurised Intraperitoneal Aerosol Chemotherapy: A Retrospective Analysis

Cited by 3 publications

References 27 publications

Consensus statement on safety measures for pressurized intraperitoneal aerosol chemotherapy

Consensus statement on safety measures for pressurized intraperitoneal aerosol chemotherapy

Histological regression of gastrointestinal peritoneal metastases after systemic chemotherapy

Testing a Model of Care for Patients on Immune Checkpoint Inhibitors Based on Electronic Patient-Reported Outcomes: Protocol for a Randomized Phase II Controlled Trial (Preprint)

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