title: Experimental development of an intra-abdominal chemohyperthermia model using a closed abdomen technique and a PRS-1.0 Combat CO2 recirculation system.
abstract: BACKGROUND
  Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is the best operative treatment currently available for patients with peritoneal carcinomatosis of ovarian origin. The open abdomen technique is the classic technique for hyperthermic intraperitoneal chemotherapy. We developed a closed abdomen model that improves temperature control and increases exposure of peritoneal surfaces to the drug by recirculating the perfusate.
  
  
  METHODS
  We used a porcine model with 12 female, Large White pigs-4 in the open technique group and 8 in the closed technique CO2 group. We performed cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for 60 minutes using paclitaxel (175 mg/m(2)) at an input temperature of 42°C. Perfusate recirculation was performed under controlled pressure (range, 12-15 mmHg). The infusion of 0.7 L of CO2 via a separate intraperitoneal infusion catheter mixed the perfusate within the peritoneal cavity. Intra-abdominal temperature was assessed using 6 intra-abdominal temperature probes and 2 temperature probes in the inflow and outflow circuits. Drug distribution was assessed using methylene blue staining.
  
  
  RESULTS
  Intra-abdominal temperatures remained constant and homogeneous in all intra-abdominal quadrants with a constant input temperature of 42°C and a minimum output temperature of 41.4°C. The infused CO2 caused the fluid to bubble and created agitation inside the abdominal cavity to facilitate a homogeneous distribution of the drug-containing perfusate.
  
  
  CONCLUSIONS
  The closed recirculation hyperthermia with intraperitoneal chemotherapy technique developed in this study is safe and feasible, and may provide a more homogeneous delivery of heated chemotherapy to the peritoneal cavity in patients with peritoneal malignancies.
authors: General Surgery Department, University General Hospital, Ciudad Real, Spain. Electronic address: susisg_83@hotmail.com.
authors: Susana
authors: S
authors: Sánchez-García
authors: General Surgery Department, University General Hospital, Ciudad Real, Spain.
authors: David
authors: D
authors: Padilla-Valverde
authors: General Surgery Department, University General Hospital, Ciudad Real, Spain.
authors: Pedro
authors: P
authors: Villarejo-Campos
authors: General Surgery Department, University General Hospital, Ciudad Real, Spain.
authors: Jesús
authors: J
authors: Martín-Fernández
authors: Pathology Department, University General Hospital, Ciudad Real, Spain.
authors: Marcial
authors: M
authors: García-Rojo
authors: Pharmacy Department, University General Hospital, Ciudad Real, Spain.
authors: Marta
authors: M
authors: Rodríguez-Martínez
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000818:Animals; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001784:Blood Gas Analysis; D001831:Body Temperature / Q000502:physiology; D002245:Carbon Dioxide / Q000008:administration & dosage / Q000627:therapeutic use*; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D003131:Combined Modality Therapy; D004195:Disease Models, Animal; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006979:Hyperthermia, Induced / Q000379:methods*; D007263:Infusions, Parenteral; D017239:Paclitaxel / Q000008:administration & dosage / Q000627:therapeutic use*; D010534:Peritoneal Neoplasms / Q000503:physiopathology / Q000628:therapy*; D013552:Swine; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D002245:Carbon Dioxide; D017239:Paclitaxel