1
|
Lee TH, Yoon K, Lee S, Choi WR, Kim KG. Comparative Sensing and Judgment Control System for Temperature Maintenance for Optimal Treatment in Hyperthermic Intraperitoneal Chemotherapy Surgery. SENSORS (BASEL, SWITZERLAND) 2024; 24:596. [PMID: 38257692 PMCID: PMC10821041 DOI: 10.3390/s24020596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
For tumors wherein cancer cells remain in the tissue after colorectal cancer surgery, a hyperthermic anticancer agent is injected into the abdominal cavity to necrotize the remaining cancer cells with heat using a hyperthermic intraperitoneal chemotherapy system. However, during circulation, the processing temperature is out of range and the processing result is deteriorated. This paper proposes a look-up table (LUT) module design method that can stably maintain the processing temperature range during circulation via feedback. If the temperature decreases or increases, the LUT transmits a command signal to the heat exchanger to reduce or increase heat input, thereby maintaining the treatment temperature range. The command signal for increasing and decreasing heat input is Tp and Ta, respectively. The command signal for the treatment temperature range is Ts. If drug temperatures below 41 and above 43 °C are input to the LUT, it sends a Tp or Ta signal to the heat exchanger to increase or decrease the input heat, respectively. If the drug's temperature is 41-43 °C, the LUT generates a Ts signal and proceeds with the treatment. The proposed system can automatically control drug temperature using temperature feedback to ensure rapid, accurate, and safe treatment.
Collapse
Affiliation(s)
- Tae-Hyeon Lee
- Department of Electronic Engineering, Gyeonggi University of Science and Technology, 269 Gyeonggigwagi–dearo, Gyeonggi–do, Siheung City 15073, Republic of Korea;
| | - Kicheol Yoon
- Medical Devices R&D Center, Gachon University Gil Medical Center, 21, 774 beon–gil, Namdong–daero Namdong–gu, Incheon 21565, Republic of Korea; (K.Y.); (S.L.); (W.R.C.)
- Department of Premedicine Course, College of Medicine, Gachon University, 38–13, 3 Dokjom–ro, Namdong–gu, Incheon 21565, Republic of Korea
| | - Sangyun Lee
- Medical Devices R&D Center, Gachon University Gil Medical Center, 21, 774 beon–gil, Namdong–daero Namdong–gu, Incheon 21565, Republic of Korea; (K.Y.); (S.L.); (W.R.C.)
- Department of Health and Safety Convergence Sciences & Health and Environmental Convergence Sciences, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
- Department of Biomedical Engineering, Gachon University, 38–13, 3 Dokjom–ro, Namdong–gu, Incheon 21565, Republic of Korea
| | - Woong Rak Choi
- Medical Devices R&D Center, Gachon University Gil Medical Center, 21, 774 beon–gil, Namdong–daero Namdong–gu, Incheon 21565, Republic of Korea; (K.Y.); (S.L.); (W.R.C.)
- Department of Biomedical Engineering, Gachon University, 38–13, 3 Dokjom–ro, Namdong–gu, Incheon 21565, Republic of Korea
- School of Electrical Engineering, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Kwang Gi Kim
- Medical Devices R&D Center, Gachon University Gil Medical Center, 21, 774 beon–gil, Namdong–daero Namdong–gu, Incheon 21565, Republic of Korea; (K.Y.); (S.L.); (W.R.C.)
- Department of Biomedical Engineering, Gachon University, 38–13, 3 Dokjom–ro, Namdong–gu, Incheon 21565, Republic of Korea
- Department of Health Sciences and Technology, Gachon Advanced Institute for Health Sciences and Technology (GAIHST), Gachon University, 38–13, 3 Dokjom–ro, Namdong–gu, Incheon 21565, Republic of Korea
| |
Collapse
|
2
|
Preclinical In Vivo-Models to Investigate HIPEC; Current Methodologies and Challenges. Cancers (Basel) 2021; 13:cancers13143430. [PMID: 34298644 PMCID: PMC8303745 DOI: 10.3390/cancers13143430] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/01/2021] [Accepted: 07/06/2021] [Indexed: 12/23/2022] Open
Abstract
Simple Summary Efficacy of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) depends on patient selection, tumor type, delivery technique, and treatment parameters such as temperature, carrier solution, type of drug, dosage, volume, and treatment duration. Preclinical research offers a powerful tool to investigate the impact of these parameters and to assists in designing potentially more effective treatment protocols and clinical trials. This study aims to review the objectives, methods, and clinical relevance of in vivo preclinical HIPEC studies found in the literature. In total, 60 articles were included in this study. The selected articles were screened on the HIPEC parameters. Recommendations are provided and possible pitfalls are discussed on the choice of type of animal and tumor model per stratified parameters and study goal. The guidelines presented in this paper can improve the clinical relevance and impact of future in vivo HIPEC experiments. Abstract Hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment modality for patients with peritoneal metastasis (PM) of various origins which aims for cure in combination with cytoreductive surgery (CRS). Efficacy of CRS-HIPEC depends on patient selection, tumor type, delivery technique, and treatment parameters such as temperature, carrier solution, type of drug, dosage, volume, and treatment duration. Preclinical research offers a powerful tool to investigate the impact of these parameters and to assist in designing potentially more effective treatment protocols and clinical trials. The different methodologies for peritoneal disease and HIPEC are variable. This study aims to review the objectives, methods, and clinical relevance of in vivo preclinical HIPEC studies found in the literature. In this review, recommendations are provided and possible pitfalls are discussed on the choice of type of animal and tumor model per stratified parameters and study goal. The guidelines presented in this paper can improve the clinical relevance and impact of future in vivo HIPEC experiments.
Collapse
|
3
|
Ortega-Deballon P, Facy O, Binquet C, Delroeux D, Rat P. CHIPOFIL: A pilot study assessing the feasibility of HIPEC without extracorporeal circuit. Pleura Peritoneum 2019; 4:20190008. [PMID: 31667330 PMCID: PMC6816282 DOI: 10.1515/pp-2019-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 07/03/2019] [Indexed: 11/23/2022] Open
Abstract
Background Heated intraperitoneal chemotherapy (HIPEC) is currently performed using an external circuit including a heating device and a pump. Available devices have several drawbacks in terms of costs, technique (flow surges due to blocked tubes) and staff safety, hindering a wider use. In a previous preclinical study conducted in animals, we placed a heating wire within the abdomen to achieve and maintain hyperthermia. Our results showed this technique is safe and effective. The present pilot study was conceived as the first use of such a device in humans, aiming to confirm its safety and efficacy. Methods This was a pilot study designed to include 13 patients undergoing HIPEC. Two sets of the prototype were placed within the abdominal cavity, one in the supramesocolic and one in the inframesocolic space. The target temperature was 42–43 °C during 30–90 min according to the protocol defined for each patient. The time to set up, heat and dismantle was measured. All complications were recorded during the first postoperative year and evaluated by an independent committee. Results Nine women and four men were included. The median time to set on the device was 25 min. The target temperature was obtained in a median of 14 min and maintained uniform and homogeneously distributed within the abdomen for the scheduled duration. A permanent stirring of the viscera was performed. No thermal injury or device-related complications were observed. There were two anastomotic leaks (only one requiring reoperation), two hemoperitoneum requiring reoperation, one evisceration and one gastroparesia. Conclusions A heating cable within the peritoneal cavity can achieve safe, simple, fast and efficient HIPEC.
Collapse
Affiliation(s)
- Pablo Ortega-Deballon
- Digestive Surgical Oncology, Equipe Avenir, 14 rue Paul Gaffarel, Dijon 21079, France.,Service de Chirurgie Digestive et Cancérologique, CHU Bocage Central, 14, rue Paul Gaffarel, Dijon Cedex 21079, France
| | - Olivier Facy
- Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | | | - Delphine Delroeux
- Digestive Surgical Oncology, University Hospital of Besançon, Besançon, France
| | - Patrick Rat
- Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| |
Collapse
|
4
|
Rana AKS, Agarwal N, Dutta S, Dokania MK, Goyal H. A Modified Low-Cost Technique of Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Two Patients: a Solution for Pseudomyxoma Peritonei in the Indian Scenario? J Gastrointest Cancer 2018; 50:983-990. [PMID: 30140971 DOI: 10.1007/s12029-018-0161-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Anil Kumar Singh Rana
- Department of Surgery, Renal Transplant Unit, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital (RMLH), Baba Kharak Singh Marg, Delhi, 110001, India
| | - Nitin Agarwal
- Department of Surgery, Renal Transplant Unit, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital (RMLH), Baba Kharak Singh Marg, Delhi, 110001, India.
| | - Sushant Dutta
- Department of Surgery, Renal Transplant Unit, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital (RMLH), Baba Kharak Singh Marg, Delhi, 110001, India
| | - Manoj Kumar Dokania
- Department of Surgery, Renal Transplant Unit, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital (RMLH), Baba Kharak Singh Marg, Delhi, 110001, India
| | - Himank Goyal
- Department of Surgery, Renal Transplant Unit, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital (RMLH), Baba Kharak Singh Marg, Delhi, 110001, India
| |
Collapse
|
5
|
González-Moreno S, Ortega-Pérez G, Alonso-Casado O, Galipienzo-García J, Linero-Noguera MJ, Salvatierra-Díaz D. Techniques and Safety Issues for Intraperitoneal Chemotherapy. Surg Oncol Clin N Am 2018; 27:495-506. [DOI: 10.1016/j.soc.2018.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
6
|
Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) delivered via a modified perfusion system for peritoneal carcinomatosis of colorectal origin. Surg Today 2016; 46:979-84. [DOI: 10.1007/s00595-016-1335-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 06/08/2015] [Indexed: 10/21/2022]
|
7
|
Sánchez-García S, Villarejo-Campos P, Padilla-Valverde D, Amo-Salas M, Martín-Fernández J. Intraperitoneal chemotherapy hyperthermia (HIPEC) for peritoneal carcinomatosis of ovarian cancer origin by fluid and CO2 recirculation using the closed abdomen technique (PRS-1.0 Combat): A clinical pilot study. Int J Hyperthermia 2016; 32:488-95. [PMID: 27056558 DOI: 10.3109/02656736.2016.1152515] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background This paper reports a study of 21 patients with peritoneal carcinomatosis from ovarian cancer who underwent cytoreductive surgery and HIPEC by means of PRS-1.0 Combat®, a new model for closed abdomen HIPEC aimed at improving fluid distribution with assistance from a CO2 recirculation system. This new technology has been previously shown to be successful in an experimental study (pig model) performed by our group, and has been approved for use in our hospital. Methods Twenty-one patients with peritoneal carcinomatosis of ovarian cancer origin were included in the study. Cytoreductive surgery and HIPEC were performed by a closed abdomen fluid and CO2 recirculation technique using the PRS-1.0 Combat(®) model. We analysed the intraoperative safety tolerance and post-operative morbidity and mortality during the first 30 days. Results Between November 2011 and March 2014 21 patients with epithelial ovarian cancer, International Federation of Gynecology and Obstetrics stage II-IV, were included in the study. During the procedure there were no significant haemodynamic or analytical disturbances. Complication rates were 38.1% and 57.14% for grade III/IV and minor (grade I/II) complications, respectively. Post-operative mortality was 4.76% (one patient). Complete cytoreductive surgery and intraperitoneal chemotherapy improved overall survival and disease-free survival in women with advanced ovarian cancer. The association of intra-abdominal hyperthermia with chemotherapy (HIPEC) increased the therapeutic benefit. Conclusions This study has shown that closed abdomen intraperitoneal chemohyperthermia by a fluid and CO2 recirculation system (PRS-1.0 Combat(®)) can be a safe and feasible model for the treatment of peritoneal carcinomatosis of ovarian cancer origin.
Collapse
Affiliation(s)
| | | | | | - Mariano Amo-Salas
- c Deparment of Mathematics , University of Castilla la Mancha , Spain
| | | |
Collapse
|
8
|
Sánchez-García S, Padilla-Valverde D, Villarejo-Campos P, Martín-Fernández J, García-Rojo M, Rodríguez-Martínez M. Experimental development of an intra-abdominal chemohyperthermia model using a closed abdomen technique and a PRS-1.0 Combat CO2 recirculation system. Surgery 2013; 155:719-25. [PMID: 24502804 DOI: 10.1016/j.surg.2013.12.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 12/06/2013] [Indexed: 02/07/2023]
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. CONCLUSION 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.
Collapse
|
9
|
Gremonprez F, Willaert W, Ceelen W. Intraperitoneal chemotherapy (IPC) for peritoneal carcinomatosis: review of animal models. J Surg Oncol 2013; 109:110-6. [PMID: 24122416 DOI: 10.1002/jso.23464] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 09/18/2013] [Indexed: 12/30/2022]
Abstract
The development of suitable animal models is essential to experimental research on intraperitoneal chemotherapy (IPC). This review of the English literature (MEDLINE) presents a detailed analysis of current animal models and gives recommendations for future experimental research. Special consideration should be given to cytotoxic drug dose and concentration, tumor models, and outcome parameters.
Collapse
Affiliation(s)
- Félix Gremonprez
- Department of Surgery, Ghent University Hospital, Ghent, Belgium
| | | | | |
Collapse
|
10
|
González-Moreno S, González-Bayón L, Ortega-Pérez G. Hyperthermic Intraperitoneal Chemotherapy. Surg Oncol Clin N Am 2012; 21:543-57. [DOI: 10.1016/j.soc.2012.07.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
11
|
Ortega-Deballon P, Facy O, Jambet S, Magnin G, Cotte E, Beltramo JL, Chauffert B, Rat P. Which method to deliver hyperthermic intraperitoneal chemotherapy with oxaliplatin? An experimental comparison of open and closed techniques. Ann Surg Oncol 2010; 17:1957-63. [PMID: 20143265 DOI: 10.1245/s10434-010-0937-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hyperthermic intraperitoneal chemotherapy (HIPEC) achieves good results in selected patients with peritoneal carcinomatosis. There are two main procedures to deliver this therapy: the open abdomen and the closed abdomen techniques. A true comparison of the two techniques has never been performed. The aim of this study was to compare blood and abdominal tissue concentrations of oxaliplatin after open and closed techniques to deliver HIPEC. METHODS Nine pigs underwent HIPEC at 42-43 degrees C for 30 min with oxaliplatin (400 mg/m(2)) according to two techniques: closed (three animals) or open (six animals). The open technique used either an external heater with a pump (three animals) or an intra-abdominal heating cable (three animals) to achieve hyperthermia. Temperature homogeneity, systemic absorption, and abdominal tissue mapping of the penetration of oxaliplatin with each technique were studied. Two additional pigs underwent hyperthermia with dyes instead of oxaliplatin to depict the distribution of the liquid within the abdomen with both techniques. RESULTS Hyperthermia was satisfactory with both techniques. The closed technique achieved higher temperatures within the diaphragmatic area, while the open technique obtained higher temperatures in the mid and lower abdomen (P < 0.001 for both comparisons). The systemic absorption of oxaliplatin was higher with the open technique (P < 0.04 for all comparisons), as was the accumulation within the abdominal cavity. The operating time for the two techniques was not greatly different. CONCLUSIONS Intraperitoneal hyperthermia can be achieved with both techniques. The open technique had far higher systemic absorption and abdominal tissue penetration of oxaliplatin than the closed technique.
Collapse
|