Safety of Health Workers During Hyperthermic Intraperitoneal Chemotherapy Procedure

Abstract

Peritoneal carcinomatosis (PC) is often considered an end-stage condition. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has emerged as the only potentially curative treatment for PC. This multimodal procedure involves aggressive multivisceral resections and peritonectomy aimed at achieving a complete cytoreduction, with no macroscopic residual tumor volume within the abdomen. After surgery, a heated chemotherapy perfusate is administered intraoperatively into the abdomen to cover all peritoneal surfaces. Thus, sufficient intraabdominal chemotherapeutic drug concentration can be achieved without systemic side effects. Hyperthermia enhances the effect of intraperitoneal chemotherapy by increasing peritoneal blood flow, by direct cytotoxic effect, and by altering the tumor microenvironment. During this procedure, the health worker is at risk of exposure to cytotoxic agents at various stages (such as through air contamination or direct contact during manipulation of perfusates or chemotherapy solutions and manipulation of objects/tissues exposed to chemotherapeutics). In addition, the use of high-voltage electrocautery during the removal of both peritoneal surfaces and tumor deposits during CRS exposes the health worker to large amounts of surgical smoke for extended periods of time. Inhalation of this smoke may pose a risk to the health-care worker. Guidelines for the safe implementation of CRS and HIPEC have not yet been established. This study summarizes the current evidence on security considerations of CRS and HIPEC management.

Keywords

• Hyperthermic intraperitoneal chemotherapy
• cytoreductive surgery
• operating personnel safety