Archives of Gynecology and Obstetrics

, Volume 290, Issue 1, pp 121–129 | Cite as

Security and efficiency of a closed-system, turbulent-flow circuit for hyperthermic intraperitoneal chemotherapy after cytoreductive ovarian surgery: perioperative outputs

  • Javier Pascual-RamírezEmail author
  • Susana Sánchez García
  • Francisco González Ruiz de la Herrán
  • Pedro Villarejo Campos
  • Carlos López de la Manzanara Cano
  • Javier Haya Palazuelo
  • David Padilla Valverde
  • Jesús Martín Fernández
Gynecologic Oncology



To present physiologic intraoperative data and immediate postoperative outcomes of patients diagnosed with epithelial ovarian cancer submitted to cytoreductive surgery and hyperthermic peritoneal intraoperative chemotherapy (HIPEC) with a closed-circuit, turbulent-flow system.

Materials and methods

A closed-circuit system with CO2 turbulent flow was used for paclitaxel HIPEC during 60 min for patients diagnosed with stage II or higher and recurrent epithelial ovarian cancer. Perioperative hemodynamic and metabolic statuses were followed, as well as physiologic recovery during the first 12 postoperative hours. A non-parametric statistical analysis was performed.


At the end of the hyperthermia phase, temperature was 37.7 ± 0.6 °C, heart rate 88 ± 19 bpm, cardiac index 2.8 ± 0.5 L min−1 m−2, stroke volume variation 14.6 ± 3.6 % and extravascular lung water 8.7 ± 1.9 mL kg−1. No hyperdynamic status was recorded. The length of stay in the ICU was 2½ days, and 12.7 ± 7 days in hospital. Average postoperative intubation time was 11.7 ± 17.4 h. At the ICU admission time, glucose, lactic acid and hemoglobin were the only values out of range, but close to normal. SOFA median was 3 at admission and 0 the following day.


A turbulent-flow, closed-circuit use for hyperthermic peritoneal intraoperative chemotherapy resulted in no hyperdynamic response or coagulopathy, had good tolerance and promoted early physiologic recovery.


Epithelial ovarian cancer Hyperthermic intraperitoneal chemotherapy Intraoperative outputs Postoperative outcomes 


Conflict of interest

Dr Villarejo has a Government grant for a Clinical Trial to compare plain surgery with surgery plus intraoperative hyperthermic paclitaxel chemotherapy. The device we used for this pilot series is the Combat PRS™ (Peritoneum Recirculation System, Galmaz Biotech, Madrid, Spain), borrowed at no cost by the owner.


  1. 1.
    Helm CW (2012) Current status and future directions of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of ovarian cancer. Surg Oncol Clin N Am 21:645–663PubMedCrossRefGoogle Scholar
  2. 2.
    Chang E, Alexander HR, Libutti SK, Hurst R, Zhai S, Fiff WD, Bartlett DL (2001) Laparoscopic continuous hyperthermic peritoneal perfusion. J Am Coll Surg 193:225–229PubMedCrossRefGoogle Scholar
  3. 3.
    Kusamura S, Younan R, Baratti D, Costanzo P, Favaro M, Gavazzi C, Deraco M (2006) Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion: analysis of morbidity and mortality in 209 peritoneal surface malignancies treated with closed abdomen technique. Cancer 106:1144–1153PubMedCrossRefGoogle Scholar
  4. 4.
    Chan DL, Morris DL, Rao A, Chua TC (2012) Intraperitoneal chemotherapy in ovarian cancer, a review of tolerance and efficacy. Cancer Manag Res 4:413–422PubMedCentralPubMedGoogle Scholar
  5. 5.
    Gesson-Paute A, Ferron G, Thomas F, de Lara EC, Chatelut E, Querleu D (2008) Pharmacokinetics of oxaliplatin during open versus laparoscopically assisted heated intraoperative intraperitoneal chemotherapy (HIPEC): an experimental study. Ann Surg Oncol 15:339–344PubMedCrossRefGoogle Scholar
  6. 6.
    Tsiftsis D, de Bree E, Romanos J, Petrou A, Sanidas E, Askoxylakis J, Zervos K, Michaloudis D (1999) Peritoneal expansion by artificially produced ascites during perfusion chemotherapy. Arch Surg 134:545–549PubMedCrossRefGoogle Scholar
  7. 7.
    Kim JH, Lee JM, Ryu KS, Lee YS, Park YG, Hur SY, Lee KH, Lee SH, Kim SJ (2010) Consolidation hyperthermic intraperitoneal chemotherapy using paclitaxel in patients with epithelial ovarian cancer. J Surg Oncol 101:149–155PubMedGoogle Scholar
  8. 8.
    Panici PB, Palaia I, Graziano M, Bellati F, Manci N, Angioli RI (2010) Intraperitoneal paclitaxel as consolidation treatment in ovarian cancer patients: a case control study. Oncology 78:20–25CrossRefGoogle Scholar
  9. 9.
    de Bree E, Rosing H, Filis D, Romanos J, Melisssourgaki M, Daskalakis M, Pilatou M, Sanidas E, Taflampas P, Kalbakis K, Beijnen JH, Tsiftsis DD (2008) Cytoreductive surgery and intraoperative hyperthermic intraperitoneal chemotherapy with paclitaxel: a clinical and pharmacokinetic study. Ann Surg Oncol 15:1183–1192PubMedCrossRefGoogle Scholar
  10. 10.
    Hofer CK, Senn A, Weibel L, Zollinger A (2008) Assessment of stroke volume variation for prediction of fluid responsiveness using the modified FloTrac and PiCCOplus system. Crit Care 12:R82PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Corcoran T, Rhodes JE, Clarke S, Myles PS, Ho KM (2012) Perioperative fluid management strategies in major surgery: a stratified meta-analysis. Anesth Analg 114:640–651PubMedCrossRefGoogle Scholar
  12. 12.
    Chia VM, O’Malley CD, Danese MD, Lindquist KJ, Gleeson ML, Kelsh MA, Griffiths RA (2013) Prevalence and Incidence of comorbidities in elderly women with ovarian cancer. Gynecol Oncol 129(2):346–352PubMedCrossRefGoogle Scholar
  13. 13.
    Raspe C, Piso P, Wiesenack C, Bucher M (2012) Anesthetic management in patients undergoing hyperthermic chemotherapy. Curr Opin Anaesthesiol 25:348–355PubMedCrossRefGoogle Scholar
  14. 14.
    Benoit L, Cheynel N, Ortega-Deballon P, Di Giacomo G, Chauffert B, Rat P (2008) Closed hyperthermic intraperitoneal chemotherapy with open abdomen: a novel technique to reduce exposure of the surgical team to chemotherapy drugs. Ann Surg Oncol 15:542–546PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Esquivel J, Sticca R, Sugarbaker P, Society of Surgical Oncology et al (2007) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: a consensus statement. Ann Surg Oncol 14:128–133PubMedGoogle Scholar
  16. 16.
    Cafiero T, Di Iorio C, Di Minno RM, Sivolella G, Confuorto G (2006) Non-invasive cardiac monitoring by aortic blood flow determination in patients undergoing hyperthermic intraperitoneal intraoperative chemotherapy. Minerva Anestesiol 72:207–215PubMedGoogle Scholar
  17. 17.
    Bickel A, Arzomanov T, Ivry S, Zveibl F, Eitan A (2004) Reversal of adverse hemodynamic effects of pneumoperitoneum by pressure equilibration. Arch Surg 139:1320–1325PubMedCrossRefGoogle Scholar
  18. 18.
    Esquivel J, Angulo F, Bland RK, Stephens AD, Sugarbaker PH (2000) Hemodynamic and cardiac function parameters during heated intraoperative intraperitoneal chemotherapy using the open ‘‘coliseum technique’’. Ann Surg Oncol 7:296–300PubMedCrossRefGoogle Scholar
  19. 19.
    Kanakoudis F, Petrou A, Michaloudis D, Chortaria G, Konstantinidou A (1996) Anaesthesia for intra-peritoneal perfusion of hyperthermic chemotherapy. Haemodynamic changes, oxygen consumption and delivery. Anaesthesia 51:1033–1036PubMedCrossRefGoogle Scholar
  20. 20.
    Sakka SG, Ruhl CC, Pfeiffer UJ, Beale R, McLuckie A, Reinhart K, Meier-Hellmann A (2000) Assessment of cardiac preload and extravascular lung water by single transpulmonary thermodilution. Intensive Care Med 26:180–187PubMedCrossRefGoogle Scholar
  21. 21.
    Vorgias G, Iavazzo C, Mavromatis J, Leontara J, Katsoulis M, Kalinoglou N, Akrivos T (2007) Determination of the necessary total protein substitution requirements in patients with advanced stage ovarian cancer and ascites, undergoing debulking surgery. Correlation with plasma proteins. Ann Surg Oncol 14:1919–1923PubMedCrossRefGoogle Scholar
  22. 22.
    Desgranges FP, Steghens A, Mithieux O, Rosay H (2010) Potential risks of thoracic epidural analgesia in hyperthermic intraperitoneal chemotherapy. J Surg Oncol 101:442PubMedGoogle Scholar
  23. 23.
    Desgranges FP, Steghens A, Rosay H, Méeus P, Stoian A, Daunizeau AL, Pouderoux-Martin S, Piriou V (2012) Epidural analgesia for surgical treatment of peritoneal carcinomatosis: a risky technique? Ann Fr Anesth Reanim 31:53–59PubMedCrossRefGoogle Scholar
  24. 24.
    Schmidt C, Creutzenberg M, Piso P, Hobbhahn J, Bucher M (2008) Peri-operative anaesthetic management of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Anaesthesia 63:389–395PubMedCrossRefGoogle Scholar
  25. 25.
    De Somer F, Ceelen W, Delanghe J, De Smet D, Vanackere M, Pattyn P, Mortier E (2008) Severe hyponatremia, hyperglycemia, and hyperlactatemia are associated with intraoperative hyperthermic intraperitoneal chemoperfusion with oxaliplatin. Perit Dial Int 28:61–66PubMedGoogle Scholar
  26. 26.
    Raft J, Parisot M, Marchal F, Tala S, Desandes E, Lalot JM, Guillemin F, Longrois D, Meistelman C (2010) Impact of the hyperthermic intraperitoneal chemotherapy on the fluid-electrolytes changes and on the acid-base balance. Ann Fr Anesth Reanim 29:676–681PubMedCrossRefGoogle Scholar
  27. 27.
    Argenta PA, Sueblinvong T, Geller MA, Jonson AL, Downs LS Jr, Carson LF, Ivy JJ, Judson PL (2013) Hyperthermic intraperitoneal chemotherapy with carboplatin for optimally-cytoreduced, recurrent, platinum-sensitive ovarian carcinoma: a pilot study. Gynecol Oncol 129:81–85PubMedCrossRefGoogle Scholar
  28. 28.
    Frenel JS, Leux C, Pouplin L, Ferron G, Berton Rigaud D, Bourbouloux E, Dravet F, Jaffre I, Classe JM (2011) Oxaliplatin-based hyperthermic intraperitoneal chemotherapy in primary or recurrent epithelial ovarian cancer: a pilot study of 31 patients. J Surg Oncol 103:10–16PubMedCrossRefGoogle Scholar
  29. 29.
    Ansaloni L, Agnoletti V, Amadori A, Catena F, Cavaliere D, Coccolini F, De Iaco P, Di Battista M, Framarini M, Gazzotti F, Ghermandi C, Kopf B, Saponara M, Tauceri F, Vallicelli C, Verdecchia GM, Pinna AD (2012) Evaluation of extensive cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with advanced epithelial ovarian cancer. Int J Gynecol Cancer 22(5):778–785PubMedCrossRefGoogle Scholar
  30. 30.
    Tentes AA, Kakolyris S, Kyziridis D, Karamveri C (2012) Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy in the treatment of advanced epithelial ovarian cancer. J Oncol 2012:358341PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Konigsrainer I, Beckert S, Becker S, Zieker D, Fehm T, Grischke EM, Lauk O, Glatzle J, Brücher B, Wallwiener D, Königsrainer A (2011) Cytoreductive surgery and HIPEC in peritoneal recurrent ovarian cancer: experience and lessons learned. Langenbecks Ach Surg 396:1077–1081CrossRefGoogle Scholar
  32. 32.
    Fagotti A, Costantini B, Vizzielli G, Perelli F, Ercoli A, Gallotta V, Scambia G, Fanfani F (2011) HIPEC in recurrent ovarian cancer patients: morbidity-related treatment and long-term analysis of clinical outcome. Gynecol Oncol 122(2):221–225PubMedCrossRefGoogle Scholar
  33. 33.
    Cascales Campos PA, Gil Martinez J, Galindo Fernandez PJ et al (2011) Perioperative fast track program in intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery in advanced ovarian cancer. Eur J Surg Oncol 37:543–548PubMedCrossRefGoogle Scholar
  34. 34.
    Deraco M, Kusamura S, Virzì S, Puccio F, Macrì A, Famulari C, Solazzo M, Bonomi S, Iusco DR, Baratti D (2011) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy as upfront therapy for advanced epithelial ovarian cancer: multi-institutional phase-II trial. Gynecol Oncol 122:215–220PubMedCrossRefGoogle Scholar
  35. 35.
    Roviello F, Pinto E, Corso G, Pedrazzani C, Caruso S, Filippeschi M, Petrioli R, Marsili S, Mazzei MA, Marrelli D (2010) Safety and potential benefit of hyperthermic intraperitoneal chemotherapy (HIPEC) in peritoneal carcinomatosis from primary or recurrent ovarian cancer. J Surg Oncol 102:663–670PubMedCrossRefGoogle Scholar
  36. 36.
    Pomel C, Ferron G, Lorimier G et al (2010) Hyperthermic intra-peritoneal chemotherapy using oxaliplatin as consolidation therapy for advanced epithelial ovarian carcinoma. Results of a phase II prospective multicentre trial. CHIPOVAC study. Eur J Surg Oncol 36:589–593PubMedCrossRefGoogle Scholar
  37. 37.
    Ceelen WP, Van Nieuwenhove Y, Van Belle S, Denys H, Pattyn P (2009) Cytoreduction and hyperthermic intraperitoneal chemoperfusion in women with heavily pretreated recurrent ovarian cancer. Ann Surg Oncol 19:2352–2359PubMedCrossRefGoogle Scholar
  38. 38.
    Lim MC, Kang S, Choi J, Song YJ, Park S, Seo SS, Park SY (2009) Hyperthermic intraperitoneal chemotherapy after extensive cytoreductive surgery in patients with primary advanced epithelial ovarian cancer: interim analysis of a phase II study. Ann Surg Oncol 16:993–1000PubMedCrossRefGoogle Scholar
  39. 39.
    Bereder J, Glehen O, Habre J (2009) Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from ovarian cancer: a multiinstitutional study of 246 patients. J Clin Oncol 27(Suppl 15):Abstract 5542Google Scholar
  40. 40.
    Pavlov MJ, Kovacevic PA, Ceranic MS, Stamenkovic AB, Ivanovic AM, Kecmanovic DM (2009) Cytoreductive surgery and modified heated intraoperative intraperitoneal chemotherapy (HIPEC) for advanced and recurrent ovarian cancer—12-year single center experience. Eur J Surg Oncol 35:1186–1191PubMedCrossRefGoogle Scholar
  41. 41.
    Guardiola E, Delroeux D, Heyd B, Combe M, Lorgis V, Demarchi M, Stein U, Royer B, Chauffert B, Pivot X (2009) Intra-operative intra-peritoneal chemotherapy with cisplatin in patients with peritoneal carcinomatosis of ovarian cancer. World J Surg Oncol 7:14PubMedCentralPubMedCrossRefGoogle Scholar
  42. 42.
    Di Giorgio A, Naticchioni E, Biacchi D, Sibio S, Accarpio F, Rocco M, Tarquini S, Di Seri M, Ciardi A, Montruccoli D, Sammartino P (2008) Cytoreductive surgery (peritonectomy procedures) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of diffuse peritoneal carcinomatosis from ovarian cancer. Cancer 113:315–325PubMedCrossRefGoogle Scholar
  43. 43.
    Bae JH, Lee JM, Ryu KS, Lee YS, Park YG, Hur SY, Ahn WS, Namkoong SE (2007) Treatment of ovarian cancer with paclitaxel- or carboplatin-based intraperitoneal hyperthermic chemotherapy during secondary surgery. Gynecol Oncol 106:193–200PubMedCrossRefGoogle Scholar
  44. 44.
    Cotte E, Glehen O, Mohamed F, Lamy F, Falandry C, Golfier F, Gilly FN (2007) Cytoreductive surgery and intraperitoneal chemo-hyperthermia for chemo-resistant and recurrent advanced epithelial ovarian cancer: prospective study of 81 patients. World J Surg 31:1813–1820PubMedCrossRefGoogle Scholar
  45. 45.
    Helm CW, Randall-Whitis L, Martin RS 3rd, Metzinger DS, Gordinier ME, Parker LP, Edwards RP (2007) Hyperthermic intraperitoneal chemotherapy in conjunction with surgery for the treatment of recurrent ovarian carcinoma. Gynecol Oncol 105:90–96PubMedCrossRefGoogle Scholar
  46. 46.
    Rufian S, Muñoz-Casares FC, Briceno J, Diaz CJ, Rubio MJ, Ortega R, Ciria R, Morillo M, Aranda E, Muntané J, Pera C (2006) Radical surgery-peritonectomy and intraoperative intraperitoneal chemotherapy for the treatment of peritoneal carcinomatosis in recurrent or primary ovarian cancer. J Surg Oncol 94:316–324PubMedCrossRefGoogle Scholar
  47. 47.
    Raspagliesi F, Kusamura S, Campos Torres JC, de Souza GA, Ditto A, Zanaboni F, Younan R, Baratti D, Mariani L, latterza B, Deraco M (2006) Cytoreduction combined with intraperitoneal hyperthermic perfusion chemotherapy in advanced/recurrent ovarian cancer patients: the experience of National Cancer Institute of Milan. Eur J Surg Oncol 32:671–675PubMedCrossRefGoogle Scholar
  48. 48.
    Look M, Chang D, Sugarbaker PH (2004) Long-term results of cytoreductive surgery for advanced and recurrent epithelial ovarian cancers and papillary serous carcinoma of the peritoneum. Int J Gynecol Cancer 14:35–41PubMedCrossRefGoogle Scholar
  49. 49.
    Ryu KS, Kim JH, Ko HS, Kim JW, Ahn WS, Park YG, Kim SJ, Lee JM (2004) Effects of intraperitoneal hyperthermic chemotherapy in ovarian cancer. Gynecol Oncol 94:325–332PubMedCrossRefGoogle Scholar
  50. 50.
    Piso M, Dahlke MH, Loss M, Schlitt HJ (2004) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in peritoneal carcinomatosis from ovarian cancer. World J Surg Oncol 2:21PubMedCentralPubMedCrossRefGoogle Scholar
  51. 51.
    Zanon C, Clara R, Chiappino I, Bortolini M, Cornaglia S, Simone P, Bruno F, De Riu L, Airoldi M, Pedani F (2004) Cytoreductive surgery and intraperitoneal chemohyperthermia for recurrent peritoneal carcinomatosis from ovarian cancer. World J Surg 28:1040–1045PubMedCrossRefGoogle Scholar
  52. 52.
    Chatzigeorgiou K, Economou S, Chrysafis G, Dimasis A, Zafiriou G, Setzis K, Lyratzopoulos N, Minopoulos G, Manolas K, Chatzigeorgiou N (2003) Treatment of recurrent epithelial ovarian cancer with secondary cytoreduction and continuous intraoperative intraperitoneal hyperthermic chemoperfusion (CIIPHCP). Zentralbl Gynakol 125:424–429PubMedCrossRefGoogle Scholar
  53. 53.
    de Bree E, Romanos J, Michalakis J, Relakis K, Georgoulias V, Melissas J, Tsiftsis DD (2003) Intraoperative hyperthermic intraperitoneal chemotherapy with docetaxel as second-line treatment for peritoneal carcinomatosis of gynaecological origin. Anticancer Res 23:3019–3027PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Javier Pascual-Ramírez
    • 1
    Email author
  • Susana Sánchez García
    • 2
  • Francisco González Ruiz de la Herrán
    • 1
  • Pedro Villarejo Campos
    • 2
  • Carlos López de la Manzanara Cano
    • 3
  • Javier Haya Palazuelo
    • 3
  • David Padilla Valverde
    • 2
  • Jesús Martín Fernández
    • 2
  1. 1.Department of AnesthesiologyHospital General Universitario de Ciudad RealCiudad RealSpain
  2. 2.Department of SurgeryHospital General Universitario de Ciudad RealCiudad RealSpain
  3. 3.Department of GynecologyHospital General Universitario de Ciudad RealCiudad RealSpain

Personalised recommendations