e., not warming airway gases or intravenous solutions and cooling the room). After cytoreductive surgery was completed, peritoneal perfusion inflow and outflow catheters were placed percutaneously into the abdominal cavity. Temperature probes were placed on the inflow and outflow catheters. The abdominal skin incision was closed temporarily with a running cutaneous suture to prevent leakage Inhibitors,research,lifescience,medical of peritoneal perfusate. A perfusion circuit was established with approximately 3 L of Ringer’s lactate. Flow rates of approximately 800 to 1000 mL/min were
maintained using a roller pump managed by the pump technician. The circuit continued through a pump, then a heat exchanger and then back to the patient. Constant temperature monitoring was performed at all temperature probes. Once inflow temperature exceeded 38.5°C, 30 mg of mitomycin C was added to the perfusate. At 60 selleck chemicals llc minutes an additional 10 mg of mitomycin C was added to keep mitomycin C perfusate concentrations higher than 5µg/mL. A maximum Inhibitors,research,lifescience,medical inflow temperature of 42.0°C was realized during perfusion, with a target outflow temperature at the pelvis of 40°C. The abdomen was gently massaged throughout perfusion to improve Inhibitors,research,lifescience,medical drug distribution to all peritoneal surfaces. Total planned perfusion
time after the initial addition of mitomycin C was 120 minutes. In certain patients (elderly individuals, those with extensive previous chemotherapy, those with inanition or poor performance status, and patients having extensive peritoneal stripping during surgery), reductions Inhibitors,research,lifescience,medical in the dose of mitomycin C (to 30 mg total) or perfusion time (to 60-90 minutes) were made due to concerns about potential toxic effects. Oxaliplatin was administered to a total of 21 of the
195 patients (11%) at a dose of 200 mg/m(2) for a total of 120 minutes; no similar reductions in dosage were needed for oxaliplatin patients (18). Postoperatively, patients had complete blood counts determined daily until discharge. Treatment with recombinant granulocyte colony stimulating factor (Neupogen) at a dose of 5µg/kg/day was initiated Inhibitors,research,lifescience,medical when their white blood cell counts were <4,000/mm. The granulocyte Tolmetin colony stimulating factor was continued until the white blood cell was >10,000/mm, a value in the normal range for our laboratory (19). Hematologic toxicity was graded on a standard scale from 0-5, with 5 being most severe using the National Cancer Institute’s Common Terminology Criteria for Adverse Events standard criteria (20). Results One hundred ninety five patients (101 women, 94 men), aged 25 to 81 years (mean 53), with peritoneal carcinomatosis underwent cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. The primary site of origin of the peritoneal carcinomatosis and R resection status are shown in Table 1. There were 101 patients (52%) who underwent a splenectomy during cytoreductive surgery. Splenectomy rates were significantly different by R resection status (P<0.