Safe temperature range for intraoperative and early postoperative continuous hyperthermic intraperitoneal perfusion in a swine model of experimental distal gastrectomy with Billroth II reconstruction

Abstract

BackgroundThe current study sought to investigate the safety of intraoperative and early postoperative continuous hyperthermic intraperitoneal perfusion (IEPCHIP) at different temperatures in a swine model of experimental distal gastrectomy with Billroth II reconstruction.MethodsThirty pigs were randomly divided into 5 groups. Two groups were used as the control groups (groups A1 and A2), and 3 groups were used as the perfusion groups (groups B, C and D). Pigs in group A1 received distal gastrectomy with Billroth II reconstruction only. Pigs in groups A2, B, C and D received the same surgery as group A1, followed by IEPCHIP at 37 ± 0.5°C, 42.5 ± 0.5°C, 43.5 ± 0.5°C or 44.5 ± 0.5°C, respectively. The perfusion time was assessed for each pig in group A2 as well as in the perfusion groups, and the perfusions were performed twice for each group. The first perfusion was conducted intraoperatively, and the second perfusion was initiated 1 day after surgery. Data concerning vital signs and hepatic and renal function were collected. Parameters concerning anastomotic healing, the pathology of the anastomotic tissue and abdominal adhesion were compared.ResultsThe vital signs and hepatic and renal functions of the pigs in groups A1, A2, B and C were not significantly affected by this procedure. In contrast, the vital signs and hepatic and renal functions of the pigs in group D were significantly affected. Compared to the pigs in groups A1, A2 or B, the anastomotic bursting pressure, breaking strength and hydroxyproline content in group C and D pigs were significantly lower. No significant differences were observed in these parameters between groups A1, A2 and B. Abdominal adhesion was more severe in group D pigs. Collagen deposition in group A1, A2 and B pigs was dense in the anastomosis, and inflammatory cell infiltration was observed in group D.ConclusionsIEPCHIP at 42.5 ± 0.5°C was safe and caused minimal impairments. However, anastomotic healing was affected by perfusion at 43.5 ± 0.5°C and 44.5 ± 0.5°C, and abdominal adhesion was most severe in the group D animals, which were perfused at 44.5 ± 0.5°C.

Dual-sized hollow particle incorporated fibroin thermal insulating coatings on catheter for cerebral therapeutic hypothermia

“…On the other hand, our thermal-insulating coating technique may show great potentials to keep warm fluid within the catheter from cooling, which can be used for maintaining a high body temperature in intensive care unit or operating room [ 58 ]. In terms of intraperitoneal hyperthermic perfusion for the treatment of cancers, the accurate control of the catheter outflow is also crucial to ensure the safety and efficacy of the therapy [ 59 ].…”

Hyperthermia During Intraperitoneal Chemotherapy With Paclitaxel or Docetaxel for Ovarian Cancer: Is There Any Benefit?

“…Although this may be primarily due to the intraoperative intraperitoneal chemotherapy rather than the hyperthermia (51), the contribution of hyperthermia may still be significant. In some animal models, local hyperthermia was associated with impaired anastomotic healing (46,49) and in other experimental studies not (45,50,52,53). In a recent study on a rat model, normothermic intraperitoneal chemotherapy with paclitaxel or hyperthermic perfusion with normal saline solution had no negative impact on anastomotic healing but the combination of hyperthermia and intraperitoneal chemotherapy with paclitaxel significantly reduced the mechanical strength of colonic anastomoses (50).…”

“…Anastomotic leakage, especially in combination with chemotherapy-induced neutropenia, contributes considerably to its morbidity. In most experimental studies (45)(46)(47)(48)(49)(50), HIPEC resulted in impaired healing of intestinal anastomoses. Although this may be primarily due to the intraoperative intraperitoneal chemotherapy rather than the hyperthermia (51), the contribution of hyperthermia may still be significant.…”

Pharmacological considerations regarding intraoperative hyperthermic intraperitoneal chemotherapy for ovarian cancer

“…Moreover, some concern exists regarding the potential increase of morbidity by addition of hyperthermia to intraperitoneal chemotherapy, including impaired healing of intestinal anastomoses [53][54][55], increased bacterial translocation from the intestine [56] and a systemic inflammatory response with severe haemodynamic derangements [57,58]. Finally, hyperthermia seems to cause increased absorption of the chemotherapeutic agent from the peritoneal cavity into the systemic circulation, which consequently may result in higher systemic toxicity [59].…”