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Laparoscopic gastrectomy and adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) using a closed system with turbulent-flow circuit: technical aspects and preliminary results of a pilot study

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Summary

Background

Intraoperative hyperthermic chemotherapy (HIPEC) is increasingly used in combination with cytoreductive surgery for the treatment of peritoneal carcinomatosis. The potential survival benefit of adjuvant HIPEC after curative gastrectomy has not been conclusively demonstrated. We describe a newly developed closed system for HIPEC and report the preliminary results of a pilot study.

Methods

Patients with locally advanced gastric carcinoma at a high risk for peritoneal recurrence were identified from a prospectively collected database. Laparoscopic total or subtotal gastrectomy combined with standard D2 lymphadenectomy was performed. Immediately after resection and 15 min before HIPEC treatment, intravenous induction chemotherapy with folinic acid and 5‑fluorouracil was administered. A closed-system HIPEC with turbulent-flow circuit (Combat PRS™, Peritoneum Recirculation System, Galmaz Biotech, Madrid, Spain) was used to perfuse the peritoneal cavity with a solution of oxaliplatin and glucose during 60 min. After washout of the peritoneal cavity and re-establishment of pneumoperitoneum, a Roux-en-Y esophagojejunostomy or gastrojejunostomy was performed.

Results

Between June 2017 and February 2018, 6 patients were treated according to this protocol. No major postoperative complications occurred. There were no intra- or postoperative complications related to the HIPEC procedure. All patients are alive and disease-free at 3–11 months of follow-up.

Conclusions

The preliminary results of this pilot study indicate the safety and feasibility of the closed HIPEC system with CO2 recirculation in selected patients undergoing laparoscopic total or subtotal gastrectomy for locally advanced gastric carcinoma.

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Authors and Affiliations

  1. Division of General Surgery, IRCCS Policlinico San Donato, Department of Biomedical Sciences for Health, University of Milan, Milano, Italy

    Daniele Bernardi, Emanuele Asti &  Luigi Bonavina

  2. Anesthesiology Unit, IRCCS Policlinico San Donato, San Donato Milanese (Milano), Italy

    Michele Punturieri

  3. Division of Medical Oncology, IRCCS Policlinico San Donato, San Donato Milanese (Milano), Italy

    Alberto Luporini

Authors
  1. Daniele Bernardi
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  2. Emanuele Asti
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  3. Michele Punturieri
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  4. Alberto Luporini
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  5. Luigi Bonavina
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Corresponding author

Correspondence to Luigi Bonavina.

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Conflict of interest

D. Bernardi, E. Asti, M. Punturieri, A. Luporini, and L. Bonavina declare that they have no competing interests.

Ethical standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all individual participants included in the study.

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Bernardi, D., Asti, E., Punturieri, M. et al. Laparoscopic gastrectomy and adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) using a closed system with turbulent-flow circuit: technical aspects and preliminary results of a pilot study. Eur Surg 50, 209–214 (2018). https://doi.org/10.1007/s10353-018-0538-9

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  • DOI: https://doi.org/10.1007/s10353-018-0538-9

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