Occupational exposure to cisplatin/oxaliplatin during Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC)?

Ametsbichler, Paul; Böhlandt, Antje; Nowak, Dennis; Schierl, Rudolf

doi:10.1016/j.ejso.2018.05.020

Cited by 31 publications

(38 citation statements)

References 24 publications

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“…A previous study reported that serum levels of vasopressin may decrease 30 minutes after capnoperitoneum, and thereby, SVR may decrease and cardiac output may increase, supporting the pharmacokinetic properties of doxorubicin after RIPAC in this study [33]. Furthermore, there were no renal and hepatic toxicities caused by RIPAC with doxorubicin consistent with relevant studies that showed a similar safety pro le after PIPAC [15,34,35]. The results indicate that RIPAC can be safely conducted like PIPAC in a clinical setting.…”

Section: Ripac Using Doxorubicin Has No Renal and Hepatic Toxicitiessupporting

confidence: 85%

Development of Rotational Intraperitoneal Pressurized Aerosol Chemotherapy to Enhance Drug Delivery into the Peritoneum

Park

Lee

et al. 2021

Preprint

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Background Pressurized intraperitoneal aerosol chemotherapy (PIPAC) has been introduced as palliative therapy for treating peritoneal metastasis (PM) of solid tumors. However, restricted use in the limited countries and the uneven distribution and penetration in various regions of the peritoneal cavity ac as disadvantages of PIPAC. Thus, the KOrean Rotational Intraperitoneal pressurized Aerosol chemotherapy (KORIA) trial group developed rotational intraperitoneal pressurized aerosol chemotherapy (RIPAC) for enhancing drug delivery into the peritoneum to treat PM, and evaluated the drug distribution, tissue concentrations, penetration depth, pharmacokinetic properties, and toxicities after RIPAC with doxorubicin in pigs. Methods For delivering doxorubicin as aerosols, we used our prototype for PIPAC, which sprayed about 30-µm sized droplets through the nozzle. The mean diameter of the sprayed region was 18.5 cm, and the penetration depth ranged from 360 to 520 µm, comparable to the microinjection pump (Capnopen®; Capnomed, Villingendorf, Germany). For RIPAC, a conical pendulum motion device was added to PIPAC for rotating the nozzle. RIPAC and PIPAC were conducted using 150 ml of 1% methylene blue to evaluate drug distribution and 3.5 mg of doxorubicin in 50 ml of 0.9% NaCl to evaluate tissue concentration and penetration depth, pharmacokinetic properties, and toxicities. All agents were sprayed as aerosols via the nozzle with a velocity of 5 km/h at a flow rate of 30 ml/min under a pressure of 7 bars, and capnoperitoneum of 12 mmHg was maintained for 30 minutes. As a control, we conducted early postoperative intraperitoneal chemotherapy (EPIC) using 1% methylene blue solution with an infusion flow rate of 100 ml/min for 30 minutes and the drainage of 1 L every 10 minutes. Results RIPAC showed a wider distribution and stronger intensity than EPIC and PIPAC. Moreover, the tissue concentration and penetration depth of doxorubicin were higher in RIPAC than in PIPAC. In RIPAC, the pharmacokinetic properties reflected hemodynamic changes during capnoperitoneum, and there were no renal and hepatic toxicities related to RIPAC using doxorubicin. Conclusions RIPAC may have the potential to enhance drug delivery into the peritoneum compared to PIPAC.

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Section: Ripac Using Doxorubicin Has No Renal and Hepatic Toxicitiessupporting

confidence: 85%

Development of Rotational Intraperitoneal Pressurized Aerosol Chemotherapy to Enhance Drug Delivery into the Peritoneum

Park

Lee

et al. 2021

Preprint

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“…Data on the occupational health and safety aspects of the technique were collected, with no evidence of platinum contamination in the operating theatres. As centres across Europe started performing the procedure, verification of its occupational health and safety was repeated. Similarly, as shown in Fig .…”

Section: Resultsmentioning

confidence: 99%

“…Overall, the search identified: 23 stage 0 studies; 18 stage 1 studies and two protocol papers for stage 1 studies; 25 stage 2a studies, one protocol paper and five trial registrations (NCT01854255, NCT02735928, NCT03246321, NCT02604784 and NCT03124394) for stage 2a studies; six stage 2b studies and three protocol papers for stage 2b studies; and three protocol papers for stage 3 studies. Fig .…”

Section: Resultsmentioning

confidence: 99%

Pressurized intraperitoneal aerosol chemotherapy: a review of the introduction of a new surgical technology using the IDEAL framework

Tate

Torkington

2020

BJS Open

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Background The IDEAL (Idea, Development, Evaluation, Assessment, Long‐term study) framework is a scheme of investigation for innovative surgical therapeutic interventions. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a procedure based on laparoscopy to deliver intraperitoneal chemotherapy for peritoneal metastases, introduced in 2011. The aim of this article was to review literature on PIPAC and assess whether development of the technique has followed the IDEAL framework. Methods A search of MEDLINE and Embase was carried out to identify scientific reports on PIPAC published between January 2000 and February 2019. The studies were categorized according to the IDEAL stages. Results Eighty‐six original research papers on PIPAC were identified. There were 23 stage 0, 18 stage 1, 25 stage 2a and six stage 2b studies. Protocol papers for stage 1, 2b and 3 studies, and trial registrations for stage 2a studies, were also identified. The number of centres publishing reports and the number of publications has increased each year. Overall, there has been progression through the IDEAL stages; however, about 60 per cent of clinical reports published in 2018 were stage 1 Idea‐type studies. Conclusion Since its introduction, studies investigating PIPAC have progressed in line with the IDEAL framework. However, the majority of studies reported recently were stage 0 and 1 studies.

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“…This use is explained mainly by the perceived need the prevent accidental inhalation of aerosolized chemotherapy. However, very low to inexistent air contamination after PIPAC has been measured [ 10 , 18 ]. Other potentially protective measures were not used because of unavailability (30%) or because these measures were not included in the respective institutional protocol (29%).…”

Section: Discussionmentioning

confidence: 99%

Current practice and perceptions of safety protocols for the use of intraperitoneal chemotherapy in the operating room: results of the IP-OR international survey

Clerc

Ashwin

Somashekhar

et al. 2021

Pleura and Peritoneum

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Objectives To assess the risk perception and the uptake of measures preventing environment-related risks in the operating room (OR) during hyperthermic intraperitoneal chemotherapy (HIPEC) and pressurized intraperitoneal aerosol chemotherapy (PIPAC). Methods A multicentric, international survey among OR teams in high-volume HIPEC and PIPAC centers: Surgeons (Surg), Scrub nurses (ScrubN), Anesthesiologists (Anest), Anesthesiology nurses (AnesthN), and OR Cleaning staff (CleanS). Scores extended from 0–10 (maximum). Results Ten centers in six countries participated in the study (response rate 100%). Two hundred and eleven responses from 68 Surg (32%), 49 ScrubN (23%), 45 Anest (21%), 31 AnesthN (15%), and 18 CleanS (9%) were gathered. Individual uptake of protection measures was 51.4%, similar among professions and between HIPEC and PIPAC. Perceived levels of protection were 7.57 vs. 7.17 for PIPAC and HIPEC, respectively (p<0.05), with Anesth scoring the lowest (6.81). Perceived contamination risk was 4.19 for HIPEC vs. 3.5 for PIPAC (p<0.01). Information level was lower for CleanS and Anesth for HIPEC and PIPAC procedures compared to all other responders (6.48 vs. 4.86, and 6.48 vs. 5.67, p<0.01). Willingness to obtain more information was 86%, the highest among CleanS (94%). Conclusions Experience with the current practice of safety protocols was similar during HIPEC and PIPAC. The individual uptake of protection measures was rather low. The safety perception was better for PIPAC, but the perceived level of protection remained relatively low. The willingness to obtain more information was high. Intensified, standardized training of all OR team members involved in HIPEC and PIPAC is meaningful.

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Occupational exposure to cisplatin/oxaliplatin during Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC)?

Cited by 31 publications

References 24 publications

Development of Rotational Intraperitoneal Pressurized Aerosol Chemotherapy to Enhance Drug Delivery into the Peritoneum

Development of Rotational Intraperitoneal Pressurized Aerosol Chemotherapy to Enhance Drug Delivery into the Peritoneum

Pressurized intraperitoneal aerosol chemotherapy: a review of the introduction of a new surgical technology using the IDEAL framework

Current practice and perceptions of safety protocols for the use of intraperitoneal chemotherapy in the operating room: results of the IP-OR international survey

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