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Laparoscopic cytoreductive surgery and HIPEC is effective regarding peritoneum tissue paclitaxel distribution

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Abstract

Background

In some patients with peritoneal carcinomatosis, we could perform the cytoreductive surgery and the HIPEC procedure by a complete laparoscopic approach to avoid morbidity. We consider that using laparoscopic approach for performing peritoneal carcinomatosis cytoreductive surgery and HIPEC with closed CO2 recirculation technique is possible and safe, with equal efficacy to conventional methods and hemodynamic complications.

Objective

Monitoring the effectiveness of the drug distribution in a laparoscopic ctoreductive and HIPEC surgery group with CO2 recirculation respect to a closed and open HIPEC group

Methods

Porcine model that included fifteen mini-pigs. Five pigs were operated with laparoscopic approach performing a pelvic and retroperitoneal lymphadenectomy. They later received a total laparoscopic closed HIPEC with CO2 recirculation (G1). Group 2 (G2): five pigs operated by an open cytoreductive surgery and closed HIPEC technique. Group 3 (G3): five animals in which an open cytoreductive surgery and an open HIPEC technique was performed. Blood and peritoneal determinations were realized after recirculation of the drug, at 60 min using chromatographic analysis.

Results

G1–G2: phrenic right peritoneum, p: 0.46. Phrenic left peritoneum, p: 0.46. Pelvic peritoneum, p: 0.17. Serum paclitaxel: p: 0.01. G1–G3: phrenic right peritoneum, p: 0.34. Phrenic left peritoneum, p: 0.34. Pelvic peritoneum, p: 0.17. Serum paclitaxel G1–G3, p: 0.02.

Conclusions

A total laparoscopic approach for ctoreductive surgery and closed HIPEC with CO2 recirculation may be safe and feasible. In our experimental model there was no significant difference in tissue drug distribution respect the conventional techniques and there was a less toxicity because the serum drug concentration was significantly lower with laparoscopic approach respect the other groups.

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Abbreviations

HIPEC:

Hyperthermic intraperitoneal chemotherapy

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Acknowledgments

To Foundation “Eugenio Rodriguez Pascual” for its Grant that allowed us to perform this project

Author information

Authors and Affiliations

  1. Department of Surgery, University General Hospital, Avd. Obispo Torija, s/n, 13005, Ciudad Real, Spain

    D. Padilla-Valverde, P. Villarejo, S. Sanchez, A. Alberca, J. Fernández, P. Marta & J. Martín

  2. Department of Anesthesiology, University General Hospital, Ciudad Real, Spain

    J. Redondo, S. Sánchez, P. Faba, V. Baladron & O. Montenegro

  3. Center for Applied Medical Research, CIMA, University of Navarra, Pamplona, Spain

    J. Oyarzabal & A. Estella

  4. Laboratory Department, University General Hospital, Ciudad Real, Spain

    T. Palomino & E. Fernandez

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  1. D. Padilla-Valverde
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Contributions

DP-V, JR, PV, JM, have made the conception,design of the study, and acquisition-analysis of data. JO, AE, TP, EF, SS, SeS, PF, VB, AA, OM, JF, PM, have made the acquisition-analysis of data. DP-V and JM have made the final approval of the version that will be submitted.

Corresponding author

Correspondence to D. Padilla-Valverde.

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Conflict of interest

The authors, David Padilla-Valverde, Pedro Villarejo, Javier Redondo, Julen Oyarzabal, Ander Estella, Teodoro Palomino, Esther Fernandez, Susana Sanchez, Sergio Sánchez, Patricia Faba MD, Victor Baladron, Ana Alberca, Javier Fernández, Omar Montenegro, Pilar Marta, Jesus Martín, report no conflicts of interest.

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Padilla-Valverde, D., Villarejo, P., Redondo, J. et al. Laparoscopic cytoreductive surgery and HIPEC is effective regarding peritoneum tissue paclitaxel distribution. Clin Transl Oncol 21, 1260–1269 (2019). https://doi.org/10.1007/s12094-019-02052-8

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