Department of Gastrointestinal Surgery, Ghent University Hospital 2K12 IC, UZ Gent, De Pintelaan 185, B-9000 Ghent, Belgium.
Eur J Surg Oncol. 2013 Jul;39(7):754-9. doi: 10.1016/j.ejso.2012.07.120. Epub 2012 Aug 9.
Hyperthermic intraperitoneal chemoperfusion (HIPEC) with oxaliplatin is increasingly used in patients with carcinomatosis from colorectal cancer. For reasons of chemical stability, oxaliplatin can only be administered in a dextrose (D5%) solution, and this causes peroperative glucose and electrolyte shifts. Here, we examined the influence of perfusion temperature on glucose and electrolyte transport, metabolic shifts, and surgical morbidity.
Patients with carcinomatosis underwent cytoreduction and HIPEC using oxaliplatin (460 mg/m(2) in D5%, open abdomen) during 30 min at 39°-41 °C. Intraperitoneal (IP) temperature was measured at three locations using thermocouple probes. The area under the temperature versus time curve (AUCt) was calculated using the trapezoid rule. The influence of perfusion temperature on surgical outcome was assessed using linear regression models and the Mann Whitney U test where appropriate.
From July 2005 until March 2011, 145 procedures were performed in 139 patients with a diagnosis of CRC (70%), pseudomyxoma peritonei (11%), ovarian cancer (10%), or miscellaneous peritoneal malignancies (9%). Postoperative mortality and major morbidity were 1.4% and 26%, respectively. Higher perfusion temperature was related to more pronounced changes in serum glucose (P = 0.058), sodium (P = 0.017), and lactate (P < 0.001). The median duration of nasogastric drainage was 5 days, and this was unrelated to perfusion temperature (P = 0.76). The GI fistula rate and reoperation rate were 12.4% and 16.5% respectively; neither was related to perfusion temperature.
In patients undergoing HIPEC with oxaliplatin, perfusion temperature exacerbates peroperative metabolic shifts but does not affect surgical outcome.
奥沙利铂腹腔内热化疗（HIPEC）在结直肠癌转移患者中应用越来越广泛。出于化学稳定性的原因，奥沙利铂只能在葡萄糖（D5%）溶液中给药，这会导致术中血糖和电解质转移。在这里，我们研究了灌注温度对葡萄糖和电解质转运、代谢变化以及手术发病率的影响。
139 例结直肠癌（70%）、假性黏液瘤（11%）、卵巢癌（10%）或其他腹膜恶性肿瘤（9%）患者行肿瘤细胞减灭术和奥沙利铂 HIPEC（D5%，460mg/m2，开放腹部）30 分钟，使用热电偶探头在三个部位测量腹腔内温度。使用梯形法则计算温度与时间曲线下面积（AUCt）。使用线性回归模型和 Mann-Whitney U 检验评估灌注温度对手术结果的影响。
2005 年 7 月至 2011 年 3 月，139 例患者共进行了 145 次手术。术后死亡率和主要发病率分别为 1.4%和 26%。较高的灌注温度与更明显的血清葡萄糖（P=0.058）、钠（P=0.017）和乳酸（P<0.001）变化相关。鼻胃管引流的中位时间为 5 天，与灌注温度无关（P=0.76）。胃瘘发生率和再次手术率分别为 12.4%和 16.5%，均与灌注温度无关。
在接受奥沙利铂 HIPEC 的患者中，灌注温度会加剧术中代谢变化，但不会影响手术结果。
