Abstract
Background
In the last 20 years, intraperitoneal chemotherapy (IPC) has been explored as a modality for the management of peritoneal metastases of gynecologic, gastrointestinal, and primary peritoneal tumors. Direct delivery of chemotherapeutic agents to the peritoneal cavity space has proved superior to systemic chemotherapy when evaluating characteristics such as drug concentration reached in the peritoneal space, penetration into peritoneal metastases, and chemotherapy-related toxicity. Traditionally, IPC is delivered by peritoneal lavage with a liquid solution. This form of delivery has limitations, including inhomogeneous intraperitoneal distribution and limited ability to penetrate tissues and metastatic nodules. An alternative mode of delivery is so-called pressurized intraperitoneal aerosol chemotherapy (PIPAC). Within this context, the present study sought to identify the pattern of spatial distribution of therapeutic solutions aerosolized into the peritoneal space using a single-port PIPAC device and ascertain whether the aerosolized method is superior to the traditional (liquid) mode of IPC delivery.
Methods
Analysis of the rate of intra-abdominal staining with aerosolized 2% silver nitrate in five porcine models.
Results
Assessment of differences in stain impregnation between the upper, middle, and lower abdomen did not reveal significant differences (p = 0.42). The median sum scores were 1 for the upper abdomen and 3 for the middle and lower abdomen.
Conclusions
Aerosolization does not reach all regions of the abdomen homogeneously. However, adequate exposure of the upper abdomen, mid-abdomen, and lower abdomen to chemotherapeutic agents can be achieved with PIPAC.
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Drs. Seitenfus, Kalil, Barros, Glehen, and Mr. Ferreira hold patents on the BhioQap device used in this study. Mr. Ferreira is employed by Bhiosupply, which manufactures and distributes the device. The other authors (Drs. Zettler, dos Santos and Cereser Junior) report no conflicts of interest.
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Seitenfus, R., Kalil, A.N., de Barros, E.D. et al. Assessment of the aerosol distribution pattern of a single-port device for intraperitoneal administration of therapeutic substances. Surg Endosc 33, 3503–3510 (2019). https://doi.org/10.1007/s00464-019-07043-y
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DOI: https://doi.org/10.1007/s00464-019-07043-y