Hyperthermic intraperitoneal chemotherapy: Nomenclature and modalities of perfusion

Abstract

Following international consensus, HIPEC should be the acronym used in the scientific literature to refer to the hyperthermic intraperitoneal chemotherapy. Several modalities of perfusion are used to deliver HIPEC: open abdominal technique (Coliseum), closed abdominal technique, peritoneal cavity expander, semi-opened abdominal technique. There is no sufficient evidence in literature confirming the superiority of one technique over the others in terms of outcome, morbidity and safety to the personnel of the operating theatre. Each option has its own operational advantages and disadvantages and future prospective studies must be conducted to establish which one is the best alternative. Today, the best technique is the one which is routinely used and improved into each specialized institution involved in the management of peritoneal surface malignancy.

Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Methodology, Drugs and Bidirectional Chemotherapy

“…Elias et al compared two groups of patients with colorectal carcinomatosis where one was treated with EPIC using 5FU and mitomycin C and the other with HIPEC using oxaliplatin 43°C. Morbidity, mortality, recurrence rate and overall survival favoured the HIPEC group [19,22].…”

“…Regardless of the rapid metabolism of the drug in the liver and at other sites in the body compartment, a large AUC ratio of peritoneal fluid to plasma was maintained. An increased risk of infection has been reported in patients who have received EPIC [19]. In a large multi-institutional retrospective study, EPIC was found to significantly increase the rate of postoperative complications in 504 patients with colorectal PC treated with CRS/IPC [21].…”

“…EPIC has the advantage of administering multiple cycles of chemotherapy over a 24-h period, with a 23-h dwell time. However, as the chemotherapeutic agents persist in the peritoneal cavity, there is a greater risk of systemic absorption and adverse effects [19]. The peritoneal surface tissues are repeatedly exposed to the cytotoxic drug, which increases the benefit of its cell cycle-specific activity [11].…”

“…It has also been studied that the closed technique increases intraperitoneal pressure, which is reported to enhance the penetrative ability of the chemotherapy. However, deficiencies have been noted in the distribution of methylene blue dye with the closed technique, which may cause a higher frequency of complications and non-uniform treatment [19].…”

Safety considerations for Health care Workers involved in Cytoreductive Surgery and Perioperative chemotherapy

“…Hospitals have designated rooms for mixing and preparation of chemotherapy/cytotoxic drugs to minimize the exposure to the staff involved in administering the treatment. In HIPEC a heated chemotherapy solution (1-2 l) is circulated in the peritoneal cavity for 30-90 min using a roller pump and circuit [40,41]. During this procedure the abdomen is either kept closed (Closed technique) or open (coliseum or open technique) [42,43].…”