Feasibility of hyperthermic pressurized intraperitoneal aerosol chemotherapy in a porcine model
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Peritoneal carcinomatosis is an unmet therapeutic need. Several types of intraperitoneal chemotherapy have been introduced. However, hyperthermic intraperitoneal chemotherapy has limited drug distribution and poor peritoneal penetration. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) does not have the benefits of hyperthermia. We developed a device to apply hyperthermic PIPAC (H-PAC) and evaluated its feasibility in a porcine model.
The device for H-PAC consisted of a laparoscopic aerosol spray and a heater to create hyperthermic capnoperitoneum. We operated on five pigs for the development of the new device and on another five pigs as a survival model. After a pilot experiment of the survival model (Pig A), a hyperthermic pressurized intraperitoneal aerosol of indocyanine green was administered after insertion of three trocars (Pig B) and laparoscopy-assisted distal gastrectomy (LADG) (Pig C) without chemotherapeutic agents. After that, H-PAC with cisplatin was administered after insertion of three trocars (Pig D) and LADG (Pig E). Autopsies were performed on postoperative day 7.
Median operation time was 85 min (80–110 min). Intraperitoneal temperature was constant for 1 h of H-PAC (38.8–40.2 °C). All five pigs were healthy and survived for 7 days. Median weight loss was 0.2 kg. Autopsy tissues of stomach, peritoneum, and jejunum were intact in all five pigs.
H-PAC was feasible and safe in a porcine model.
KeywordsHyperthermia Pneumoperitoneum Aerosol Peritoneum therapy Laparoscopic surgery Peritoneal carcinomatosis
Hyung-Ho Kim has been awarded the research grant from Health Connect which provides health care services through convergence of Seoul National University Hospital and SK Telecom, Korea (Grant No.: 06-2014-158).
Compliance with ethical standards
Do Hyun Jung, Sang Yong Son, Aung Myint Oo, Young Suk Park, Dong Joon Shin, Sang-Hoon Ahn, Do Joong Park, and Hyung-Ho Kim have no conflicts of interest or financial ties to disclose.
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