Investigations on safety of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) with Mitomycin C.
OBJECTIVE
Previous safety monitoring of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) with Mitomycin C (MMC) did not demonstrate any detectable safety hazard to the personnel. Nevertheless, those results have been discussed controversially because of the methodological problems employed in the evaluation of potential exposure. We re-evaluated possible safety hazards of HIPEC by applying different monitoring strategies.


METHODS
We monitored air samples in the operation room during HIPEC. In addition, we measured MMC in plasma of the surgeon with a newly developed analytical method. All samples were analysed by HPLC-UV at 360nm. The permeability of the gloves was tested using two in vitro techniques: diffusion cells and a glass cell chamber. In-use and worst-case exposure scenarios were imitated for in vitro experiments.


RESULTS
The analysis of the air samples (n=3) could not detect any MMC. We found no drug above the limit of detection (1microg MMC/L) in the plasma samples of the surgeons (n=5). A breakthrough of latex glove material was detected in only one (worst-case exposure scenario) of 40 diffusion cell experiments.


CONCLUSIONS
Established methods of safety monitoring could not reveal any detectable risk on in-use exposure conditions. The wearing of doubled latex gloves should prevent the surgeon from dermal exposure to MMC during HIPEC.
Schmid
K
K
Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine of the University Erlangen-Nuremberg, Schillerstrasse 25 + 29, D-91054 Erlangen, Germany. klaus.schmid@rzmail.uni-erlangen.de
Boettcher
M I
MI
Pelz
J O W
JO
Meyer
T
T
Korinth
G
G
Angerer
J
J
Drexler
H
H
D000395:Air Pollutants, Occupational / Q000032:analysis; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage* / Q000009:adverse effects / Q000032:analysis / Q000493:pharmacokinetics; D002851:Chromatography, High Pressure Liquid; D003131:Combined Modality Therapy; D017575:Gloves, Protective; D006801:Humans; D006979:Hyperthermia, Induced; D007430:Intraoperative Care; D008505:Medical Staff, Hospital; D016685:Mitomycin / Q000008:administration & dosage* / Q000009:adverse effects / Q000032:analysis / Q000493:pharmacokinetics; D016273:Occupational Exposure; D016272:Occupational Health; D009873:Operating Rooms; D010534:Peritoneal Neoplasms / Q000601:surgery*
D000395:Air Pollutants, Occupational; D000903:Antibiotics, Antineoplastic; D016685:Mitomycin