Heated intraoperative intraperitoneal chemotherapy—The challenges of bringing chemotherapy into surgery

AORN Journal,  Dec, 2004  by Patricia Foltz,  Cheryl Wavrin,  Robert Sticca

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June 30, 2003 (first procedure)/Aug 21, 2003 (HIIC): A 75-year-old woman presented with acute, right lower quadrant abdominal pain and underwent an exploratory laparotomy during which a gelatinous mass that had spread throughout her abdominal cavity and an enlarged appendix were discovered. The mass was biopsied, sent for frozen section, and identified as pseudomyxoma peritonei, which usually arises from the appendix. The surgeon proceeded with a right hemicolectomy and appendectomy, but at that time HIIC had never been performed at Altru Health System. Two months later, the patient underwent a second surgery in which all remaining tumor was removed, along with her uterus and ovaries. The patient received mitomycin C during the HIIC portion of the procedure. The procedure lasted seven hours and 15 minutes. Fifteen months later, the patient is doing well with no evidence of recurrence on CT scan and colonoscopy.

Aug 15, 2003 (HIIC only): A 44-year-old married man with three young children presented with vague abdominal pain and abdominal distention. ACT scan showed ascites and a pelvic mass. A biopsy was performed, which showed mesothelioma. The patient's prognosis before HIIC was four to six months to live. The patient underwent an 18.5 hour HIIC procedure during which his spleen, gallbladder, part of his pancreas, 80% of his colon, 30% of his small bowel, and 50% of his stomach were removed. The chemotherapeutic agent used was cisplatin. The patient was transferred from the OR with a potentially reversible colostomy. He remained in the hospital for one month, during which time he developed borderline renal failure. Fifteen months after discharge his renal failure is improved and he is functioning well at home. Currently, he has no evidence of recurrence and his prognosis is good.

Patricia Foltz, RN, BSN, is the patient care supervisor and quality improvement coordinator at Altru Health System, Grand Forks, ND.

Cheryl Wavrin, RN, BSN, was the surgery quality improvement coordinator at Altru Health System, Grand Forks, ND, at the time this article was written.

Robert Sticca, MD, FACS, is surgical oncologist, program director, and vice chairman for the department of surgery at the University of North Dakota, Grand Forks, ND.

Editors' note: The authors acknowledge the administrative staff members of Altru Health System for their support during implementation of this program.

NOTES

(1.) A D Stephens et al, "Hyperthermic intraoperative intraperitoneal chemotherapy tutorial," http://www.surgicaloncology.com/hiicman .htm (accessed 22 Oct 2004).

(2.) V J Verwaal et al, "Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer," Journal of Clinical Oncology 21 (October 2003) 3737-3743.

(3.) B W Loggie et al, "Cytoreductive surgery with intraperitoneal hyperthmic chemotherapy for disseminated peritoneal cancer of gastrointestinal origin," American Surgeon 66 (June 2000) 561-568.