Are there intra-operative hemodynamic differences between the Coliseum and closed HIPEC techniques in the treatment of peritoneal metastasis? A retrospective cohort study

Abstract

BackgroundAlthough two main methods of intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) are currently accepted, the superiority of one over the other has not yet been demonstrated. The purpose of this study was to determine whether there are hemodynamic and temperature differences between patients who received HIPEC in two different techniques, open versus closed abdomen.MethodsThis retrospective study was conducted in our center between 2011–2015 in 30 patients who underwent surgery for peritoneal carcinomatosis secondary to colorectal cancer, in whom cytoreduction and HIPEC were performed by the Coliseum (15) or closed techniques (15). The main end points were morbidity, mortality, hemodynamic changes, and abdominal temperature. The comparative analysis of quantitative variables at different times was done with the parametric repeated measure ANOVA for those variables that fulfilled the suppositions of normality and independence and the Friedman non-parametric test for the variables that did not fulfill either of these suppositions.ResultsThere were no deaths in either group. The incidence of postoperative complications in the Coliseum group was 53% (8 patients), grade II–III. The incidence of complications in the closed group was 13% (2 patients), grade II–III. The intra-operative conditions regarding the systolic and diastolic pressures were more stable using the closed abdomen technique (but not significantly so). We found statistically significant differences in abdominal temperature in favor of the closed technique (p = 0.009).ConclusionsBoth HIPEC procedures are similar. In our series, the closed technique resulted in a more stable intra-abdominal temperature.

Colorectal Peritoneal Metastases: A Systematic Review of Current and Emerging Trends in Clinical and Translational Research

“…Nine studies were identified that evaluated HIPEC related morbidity, mortality, drug penetration, and distribution [46, 51, 52, 55, 59, 60, 62, 67, 68]. Two main HIPEC techniques are employed: the open abdomen (Coliseum) technique and the closed abdomen technique.…”

Comparison of open and closed hyperthermic intraperitoneal chemotherapy: Results from the United States hyperthermic intraperitoneal chemotherapy collaborative

“…Another argument for open HIPEC is the ability for better temperature homogeneity[ 7 ]. On the other hand, a downside of open HIPEC is achieving and maintaining hyperthermic temperatures given the dissipation of heat from the open abdomen[ 10 ]. Our study would suggest that these different parameters are unlikely to confer a survival advantage for either HIPEC method.…”

“…The optimal method of HIPEC delivery has long been debated. Previous investigations have been limited to small single center retrospective reviews[ 9 , 10 ] or preclinical animal models[ 11 - 13 ]. Therefore, we sought to evaluate the impact of open vs closed HIPEC technique on short- and long-term outcomes, using a large multi-institutional database.…”

Variation in Clinical Application of Hyperthermic Intraperitoneal Chemotherapy: A Review

“…All advantages and disadvantages regarding the choice of technique are listed in Table 4. Despite the different advantages and disadvantages of the delivery techniques, the clinical outcome in terms of survival and morbidity rates is similar [55,56,57]. Differences in intraoperative parameters, such as blood pressure, pulse rate, core temperature, etc., are also not statistically significant between the techniques [55].…”