Journal article
Pressurized IntraPeritoneal Aerosol Chemotherapy - Practical aspects.
- Hübner M Department of Visceral Surgery, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland. Electronic address: martin.hubner@chuv.ch.
- Grass F Department of Visceral Surgery, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland. Electronic address: fabian.grass@chuv.ch.
- Teixeira-Farinha H Department of Visceral Surgery, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland. Electronic address: hugo.teixeira-farinha@chuv.ch.
- Pache B Department of Visceral Surgery, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland. Electronic address: basile.pache@chuv.ch.
- Mathevet P Department of Gynecology, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland. Electronic address: patrice.mathevet@chuv.ch.
- Demartines N Department of Visceral Surgery, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland. Electronic address: demartines@chuv.ch.
- 2017-04-23
Published in:
- European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. - 2017
Intraperitoneal chemotherapy
Learning curve
PIPAC
Peritoneal carcinomatosis
Surgical technique
Aerosols
Antineoplastic Combined Chemotherapy Protocols
Carcinoma
Cisplatin
Colorectal Neoplasms
Doxorubicin
Feasibility Studies
Female
Humans
Learning Curve
Male
Organoplatinum Compounds
Ovarian Neoplasms
Oxaliplatin
Peritoneal Neoplasms
Stomach Neoplasms
English
INTRODUCTION
Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) has been introduced as novel treatment for peritoneal carcinomatosis. Only proper patient selection, stringent safety protocol and careful surgery allow for a secure procedure. We hereby report the essentials for safe implementation.
METHODS
All consecutive procedures within 20 months after PIPAC implementation were analyzed with regards to practical and surgical aspects. Special emphasis was laid on modifications of technique and safety measures during the implementation process with systematic use of a dedicated checklist. Further, surgical difficulty was documented by use of a visual analogue scale (VAS).
RESULTS
127 PIPAC procedures were performed in 58 patients from January 2015 until October 2016. 81% of patients had at least one previous laparotomy. Median operation time was 91 min (87-103) for the first 20 cases, 93 min (IQR 88-107) for PIPAC21-50, and 103 min (IQR 91-121) for the following 77 procedures. Primary and secondary non-access occurred in 3 patients (2%), all of them having prior hyperthermic intraperitoneal chemotherapy (HIPEC). Using open Hasson technique, one single bowel lesion occurred, which was the only intraoperative complication. One 5 mm and another 10/12 mm trocar were used in 88% of procedures while additional trocars were needed in 12%. No leak of cytostatics was observed and no procedure needed to be stopped. VAS for overall difficulty of the procedure was 3 ± 2.4, and 3 ± 2.9 and 3 ± 2.5, respectively, for abdominal access and intraoperative staging.
CONCLUSIONS
With standardized surgical approach and dedicated safety checklist, PIPAC can be safely introduced in clinical routine with minimal learning curve.
Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) has been introduced as novel treatment for peritoneal carcinomatosis. Only proper patient selection, stringent safety protocol and careful surgery allow for a secure procedure. We hereby report the essentials for safe implementation.
METHODS
All consecutive procedures within 20 months after PIPAC implementation were analyzed with regards to practical and surgical aspects. Special emphasis was laid on modifications of technique and safety measures during the implementation process with systematic use of a dedicated checklist. Further, surgical difficulty was documented by use of a visual analogue scale (VAS).
RESULTS
127 PIPAC procedures were performed in 58 patients from January 2015 until October 2016. 81% of patients had at least one previous laparotomy. Median operation time was 91 min (87-103) for the first 20 cases, 93 min (IQR 88-107) for PIPAC21-50, and 103 min (IQR 91-121) for the following 77 procedures. Primary and secondary non-access occurred in 3 patients (2%), all of them having prior hyperthermic intraperitoneal chemotherapy (HIPEC). Using open Hasson technique, one single bowel lesion occurred, which was the only intraoperative complication. One 5 mm and another 10/12 mm trocar were used in 88% of procedures while additional trocars were needed in 12%. No leak of cytostatics was observed and no procedure needed to be stopped. VAS for overall difficulty of the procedure was 3 ± 2.4, and 3 ± 2.9 and 3 ± 2.5, respectively, for abdominal access and intraoperative staging.
CONCLUSIONS
With standardized surgical approach and dedicated safety checklist, PIPAC can be safely introduced in clinical routine with minimal learning curve.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.ejso.2017.03.019
- PMID 28431896
- Persistent URL
- https://folia.unifr.ch/global/documents/259578
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