Systemic inflammatory response after hyperthermic intraperitoneal chemotherapy (HIPEC): The perfusion protocol...

Area of Science:

• Oncology
• Surgical Oncology
• Peritoneal Metastasis Treatment

Background:

• Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) is established for peritoneal metastasis.
• The underlying pathophysiology of HIPEC is not fully understood, with varied treatment protocols in use.
• This study investigates the postoperative systemic inflammatory reaction differences across HIPEC regimens.

Purpose of the Study:

• To elucidate the impact of different HIPEC protocols on postoperative systemic inflammation.
• To compare inflammatory markers following varying perfusion times and chemotherapeutic agents in HIPEC.

Main Methods:

• Three HIPEC protocols were employed: mitomycinC/doxorubicin (90 min), cisplatin (90 min), and oxaliplatin (30 min).
• Systemic inflammatory markers including C-reactive protein (CRP), white blood cells (WBC), pancreatic stone protein (PSP), and 16s rDNA were serially measured.
• Data from 140 patients across two European centers were analyzed.

Main Results:

• A secondary inflammatory peak (CRP, PSP) was observed after 90-min HIPEC with mitomycinC/doxorubicin or cisplatin, but not with 30-min oxaliplatin.
• Postoperative serum 16s rDNA levels were 2.1 times higher in patients undergoing 90-min HIPEC compared to 30-min oxaliplatin.
• These inflammatory changes were noted in patients without postoperative complications.

Conclusions:

• A distinct secondary inflammatory response occurs after 90-min HIPEC using mitomycinC/doxorubicin or cisplatin.
• Short-course 30-min HIPEC with oxaliplatin did not elicit this secondary inflammatory reaction.
• Understanding these protocol-dependent acute-phase protein dynamics is crucial for managing patients post-HIPEC.