Schredl Philipp, Ramspott Jan Philipp, Neureiter Daniel, Emmanuel Klaus, Jäger Tarkan
Department of Surgery, Paracelsus Medical University, Salzburger Landeskliniken (SALK), Müllner Hauptstraße 48, Salzburg, Austria.
Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Henricistraße 92, Essen, Germany.
Pleura Peritoneum. 2020 Feb 26;5(1):20190031. doi: 10.1515/pp-2019-0031. eCollection 2020 Mar 1.
The body surface area (BSA) is taken as a measure for the effective contact area for dosing in hyperthermic intraperitoneal chemotherapy (HIPEC). Currently, the pharmacokinetic effect of the reduced peritoneal surface area (PSA) after cytoreductive surgery (CRS) during HIPEC remains unclear. Here a proprietary software solution (PEritoneal SUrface CAlculator (PESUCA)) to quantify the resected PSA in patients with peritoneal surface malignancies (PSM) undergoing CRS and HIPEC is presented.
The PESUCA tool was programmed as a desktop and online software solution. The applicability was evaluated in 36 patients. The programming-algorithm is briefly summarized as follows: (1) calculation of BSA, (2) correlation to PSA, (3) calculation of the relative proportion of 40 different anatomical regions to total PSA before CRS, (4) instantaneous input of each resected proportion in the 40 anatomical regions during CRS, and (5) determination of the resected and remaining PSA after CRS.
The proof of concept revealed a mean PSA of all patients before CRS of 18,741 ± 321 cm compared to 13,611 ± 485 cm after CRS (p<0.0001). Patients' supramesocolic and inframesocolic visceral and parietal peritoneal area before and after CRS procedure were quantitatively determined.
Here the first tool that enables detailed PSA quantification in patients with PSM undergoing CRS is presented. This makes the software a valuable contribution to ensue more accurate assessment and improved comparability of peritoneal disease extent. Furthermore, after external validation, PESUCA could be the basis for dose adjustment of intraperitoneal chemotherapy regimens based on the remaining PSA after CRS.
在热灌注化疗（HIPEC）中，体表面积（BSA）被用作给药有效接触面积的衡量指标。目前，HIPEC期间细胞减灭术（CRS）后腹膜表面积（PSA）减少的药代动力学效应尚不清楚。本文介绍了一种用于量化接受CRS和HIPEC的腹膜表面恶性肿瘤（PSM）患者切除的PSA的专有软件解决方案（腹膜表面计算器（PESUCA））。
PESUCA工具被编程为桌面和在线软件解决方案。在36例患者中评估了其适用性。编程算法简要概括如下：（1）计算BSA，（2）与PSA相关，（3）计算CRS前40个不同解剖区域相对于总PSA的相对比例，（4）在CRS期间即时输入40个解剖区域中每个切除的比例，以及（5）确定CRS后切除的和剩余的PSA。
概念验证显示，所有患者CRS前的平均PSA为18,741±321平方厘米，而CRS后的平均PSA为13,611±485平方厘米（p<0.0001）。定量测定了患者CRS前后的结肠上和结肠下内脏及壁腹膜面积。
本文介绍了首个能够对接受CRS的PSM患者进行详细PSA量化的工具。这使得该软件对更准确地评估和提高腹膜疾病范围的可比性具有重要贡献。此外，经过外部验证后，PESUCA可作为基于CRS后剩余PSA调整腹腔化疗方案剂量的基础。
