A phase I, nonrandomized controlled trial demonstrating the novel technique of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy utilizing warm humidified carbon dioxide insufflation

Abstract

Aim:The aim of this work was to report on the safety and feasibility of warm humidified CO 2 (WHCO 2 ) insufflation during cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Method:Ten consecutive patients with histologically confirmed peritoneal cancer were enrolled in this phase I pilot nonrandomized controlled trial. They were alternately assigned to CRS and HIPEC with WHCO 2 versus standard procedure. WHCO 2 was delivered at 10 L/min, a pressure of 4.5 bar, 37ºC and 98% relative humidity during CRS using the HumiGard TM system. HIPEC was performed with an open abdomen using the Coliseum technique at 42ºC for 60 min. All patients were admitted to the intensive care unit and commenced on total parenteral nutrition postoperatively. Surface and core temperatures were measured every 30 min using an infrared camera and nasopharyngeal probe, respectively. Clinicopathological, intra-and postoperative details were collated between groups, and median surface and core temperatures were statistically compared.Results: Surface and core temperatures were generally higher in the WHCO 2 group. Core temperature at 120 and 180 min was significantly higher in the WHCO 2 versus the non-WHCO 2 group (p = 0.028 and 0.008, respectively). There was a significant linear relationship between core and surface temperature at 30, 60, 90, 120, 150 and 180 min (p = 0.033, 0.004, 0.007, 0.021, 0.009 and 0.006, respectively). The peritoneal cancer index was lower but the estimated blood loss was higher in the non-WHCO 2 than the WHCO 2 group. Conclusion:WHCO 2 in CRS and HIPEC appears to be safe and feasible. An appropriately powered phase II trial will be required to determine if WHCO 2 is associated with improved intra-and postoperative outcomes.

Summary of the best evidence for the prevention of intraoperative unplanned hypothermia in patients undergoing laparoscopic surgery

“…CO 2 is highly soluble in the blood, so it can be absorbed by the body and discharged from the lungs without leaving a legacy. The core and skin temperature are higher in warm and humidified CO 2 (6). The Asia Pacific Society of Infection Control (APSIC) guidelines for the prevention of surgical site infections [2019] emphasizes that hypothermia is an important factor affecting the occurrence of surgical site infection (7).…”