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Pressurized intraperitoneal aerosol chemotherapy (PIPAC) might increase the risk of anastomotic leakage compared to HIPEC: an experimental study

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Abstract

Background

Pressurized intraperitoneal aerosol chemotherapy (PIPAC) and hyperthermic intraperitoneal chemotherapy (HIPEC) are technics proposed to treat patients with peritoneal carcinomatosis, in different settings. There is some concern about an over-risk of anastomotic leakage (AL) with PIPAC jeopardizing a combination with cytoreductive surgery. This study used a healthy swine model to compare the postoperative AL rate between PIPAC and HIPEC with digestive resection and to analyze macrocirculation and microcirculation parameters.

Methods

Segmental colonic resection with a handsewn anastomosis was performed on 16 healthy pigs; 8 pigs had a PIPAC procedure with 7.5 mg/m2 cisplatin (PIPAC group), and 8 pigs had a closed HIPEC procedure with 70 mg/m2 cisplatin and 42 °C as the target intraperitoneal temperature (HIPEC group). Pigs were kept alive for 8 days, then sacrificed and autopsied to look for AL, which was defined as local abscess or digestive fluid leakage when pressure was applied to the anastomosis. Food intake, weight, and core temperature were monitored postoperatively. Macrocirculation (heart rate, systolic blood pressure) and microcirculation parameters (percentage of perfused vessels, perfused vessels density, DeBacker score) were evaluated intraoperatively at five timepoints. Results were compared between pigs with AL and those without.

Results

The HIPEC group had no AL, but 3 of 8 pigs (37.5%) had AL in the PIPAC group (p = 0.20). Heart rate and core temperature showed perioperative increases in the HIPEC group. Intraoperatively, heart rate was higher in the HIPEC group at the two last timepoints (123 vs. 93 bpm, p = 0.031, and 110 vs. 85 bpm, p = 0.010, at timepoints 3 and 4, respectively). Other macrocirculatory and microcirculatory parameters showed no significant differences.

Conclusion

In this healthy swine model, PIPAC might have increased AL incidence compared to HIPEC. This potential over-risk did not seem to be related to changes in the microcirculation. PIPAC should probably not be used with digestive resection and should be avoided in cases of perioperative serosal injury.

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Funding

This study was supported by an Antonin Poncet Grant from Lyon University (Grant number:2016/17).

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Authors and Affiliations

  1. Department of Digestive Surgery, Lyon-Sud University Hospital, Lyon, France

    Clément Tavernier, Guillaume Passot, Naoual Bakrin, Mohammad Alyami, Axel Davigo, Olivier Glehen & Vahan Kepenekian

  2. EMR 3738, Lyon 1 University, Lyon, France

    Clément Tavernier, Guillaume Passot, Naoual Bakrin, Mohammad Alyami, Axel Davigo, Olivier Glehen & Vahan Kepenekian

  3. Department of Intensive Care, Lyon-Sud University Hospital, Lyon, France

    Oliva Vassal & Bernard Allaouchiche

  4. University of Lyon, VetAgro Sup, APCSe, Marcy l’Étoile, France

    Bernard Allaouchiche, Jeanne-Marie Bonnet, Vanessa Louzier & Christian Paquet

  5. Pole IMER, Lyon, France

    Evelyne Decullier

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  1. Clément Tavernier
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Correspondence to Vahan Kepenekian.

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Drs. Clément Tavernier, Guillaume Passot, Oliva Vassal, Bernard Allaouchiche, Evelyne Decullier, Naoual Bakrin, Mohammad Alyami, Axel Davigo, Jeanne-Marie Bonnet, Vanessa Louzier, Christian Paquet, Olivier Glehen, and Vahan Kepenekian have no conflicts of interest or financial ties to disclose.

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Tavernier, C., Passot, G., Vassal, O. et al. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) might increase the risk of anastomotic leakage compared to HIPEC: an experimental study. Surg Endosc 34, 2939–2946 (2020). https://doi.org/10.1007/s00464-019-07076-3

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