Hemicolectomy with concomitant heated intraperitoneal chemotherapy: a case study

The use of heated intraperitoneal chemotherapy is an emerging new adjunct in the treatment of adenocarcinoma of the colon. However, documentation regarding perfusion circuitry and techniques associated with this therapy remain largely undescribed. After consultation with the surgical service team, a custom designed circuit was constructed for this procedure. Institutional approval and informed consent were obtained for surgical debulking and heated intraperitoneal chemotherapy for a 58-year old female. After surgical resection, a right hemicolectomy was performed and pathological specimens obtained. A modified custom circuit using a roller pump was first primed with 3 liters of Dianeal PD-2 and recirculated until temperature of 41 degrees C was obtained. The circuit was then connected to the patient for infusion of perfusate via Blake drains placed in the deep pelvis. Two additional drains were placed in the subdiaphragmatic space for return. Perfusate containing 30 mg of Mitomycin-C was circulated at 600-800 mL/min for 60 min at 41 degrees C. An additional 10 mg of Mitomycin-C was then administered through the circuit for an additional hour under similar conditions. Upon completion, a washout procedure was performed with 2 additional liters of Dianeal PD-2. The patient tolerated the procedure well and was discharged postoperative day 7. We describe the successful use of a perfusion-administered heated intraperitoneal chemotherapy regimen as an integral part of successful treatment of adenocarcinoma of the colon.