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Continuous leakage measurement during hyperthermic isolated limb perfusion.
D Daryanani1, R Komdeur, J Ter Veen
1Division of Surgical Oncology, University Hospital Groningen, The Netherlands.
Annals of Surgical Oncology
|August 18, 2001
Summary
Perfusate leakage during isolated limb perfusion significantly decreased from 1977-2000. Using TNFalpha and improved monitoring techniques minimized systemic leakage, enhancing patient safety in cancer treatment.
Area of Science:
- Oncology
- Surgical Oncology
- Pharmacology
Background:
- Continuous monitoring of perfusate leakage into systemic circulation is critical.
- Radioactive tracers enable precise measurement of this leakage.
- Understanding changes in leakage rates and contributing factors is essential for improving patient outcomes.
Purpose of the Study:
- To assess changes in perfusion leakage rates between 1977-1990 and 1991-2000.
- To identify factors influencing these changes in leakage rates.
Main Methods:
- 119 patients underwent isolated limb perfusion (HILP) for melanoma or sarcoma (1991-2000).
- Perfusions used melphalan or melphalan with TNFalpha.
- Systemic leakage was continuously monitored using 131I-albumin and a scintillation detector.
Main Results:
- Median maximum leakage was 2.7% (1991-2000), significantly lower than 8% (1977-1990).
- Iliac and femoral perfusions showed higher leakage than axillary and popliteal.
- Less leakage was observed when TNFalpha was used compared to melphalan alone.
Conclusions:
- Systemic leakage during isolated perfusions has been significantly minimized.
- Key improvements include increased awareness of TNFalpha leakage, continuous 131I-albumin monitoring, and optimized flow rate and blood pressure regulation.
- These advancements contribute to enhanced safety in isolated limb perfusion procedures.