Investigations on safety of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) with Mitomycin C
K Schmid1, M I Boettcher, J O W Pelz
1Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine of the University Erlangen-Nuremberg, Schillerstrasse 25 + 29, D-91054 Erlangen, Germany. klaus.schmid@rzmail.uni-erlangen.de
Aims:
Previous safety monitoring of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) with Mitomycin C (MMC) did not demonstrate any detectable safety hazard to the personnel. Nevertheless, those results have been discussed controversially because of the methodological problems employed in the evaluation of potential exposure. We re-evaluated possible safety hazards of HIPEC by applying different monitoring strategies.
Methods:
We monitored air samples in the operation room during HIPEC. In addition, we measured MMC in plasma of the surgeon with a newly developed analytical method. All samples were analysed by HPLC-UV at 360nm. The permeability of the gloves was tested using two in vitro techniques: diffusion cells and a glass cell chamber. In-use and worst-case exposure scenarios were imitated for in vitro experiments.
Results:
The analysis of the air samples (n=3) could not detect any MMC. We found no drug above the limit of detection (1microg MMC/L) in the plasma samples of the surgeons (n=5). A breakthrough of latex glove material was detected in only one (worst-case exposure scenario) of 40 diffusion cell experiments.
Conclusions:
Established methods of safety monitoring could not reveal any detectable risk on in-use exposure conditions. The wearing of doubled latex gloves should prevent the surgeon from dermal exposure to MMC during HIPEC.
Insights
Hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) with Mitomycin C (MMC) poses no detectable risk to surgical personnel under normal use. Double-gloved surgeons are protected from dermal exposure to MMC during HIPEC procedures.
Area of Science:
- Oncology
- Surgical Oncology
- Pharmacology
Background:
- Previous safety monitoring of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) with Mitomycin C (MMC) has faced methodological criticisms regarding personnel exposure.
- Concerns persist about potential safety hazards for healthcare professionals during HIPEC procedures.
Purpose of the Study:
- To re-evaluate the safety hazards associated with HIPEC using Mitomycin C (MMC).
- To apply diverse monitoring strategies to assess personnel exposure during HIPEC procedures.
Main Methods:
- Air samples from the operating room during HIPEC were monitored.
- Mitomycin C (MMC) levels in surgeon plasma were measured using a novel analytical method (HPLC-UV at 360nm).
- In vitro glove permeability was assessed using diffusion cells and a glass cell chamber under simulated exposure scenarios.
Main Results:
- No MMC was detected in analyzed air samples (n=3).
- MMC levels in surgeon plasma samples (n=5) were below the limit of detection (1microg MMC/L).
- Glove breakthrough occurred in only one of 40 in vitro experiments under worst-case exposure conditions.
Conclusions:
- Current safety monitoring methods indicate no detectable risk from in-use exposure to MMC during HIPEC.
- The use of double-layered latex gloves is recommended to prevent dermal exposure to MMC for surgeons during HIPEC.
