Current Techniques of Hyperthermic Isolated Limb Perfusion for Malignant Melanoma

Abstract

A retrospective study was conducted examining 25 patients with malignant melanoma who were treated by our new protocol for hyperthermic isolated limb perfusion. The characteristics of our techniques include: a lower priming volume of the extracorporeal circuit; a therapeutic temperature range of 40-41 degrees C with 60 min hyperthermic perfusion; a nominal perfusion flow rate of 500 ml/min in the lower limb and 200 ml/min in the upper limb; and combined carboplatin with interferon-beta as the adjuvant chemotherapy drug. In the lower extremity group, the arterial cannula size ranged from 8 to 14 F, while the venous cannula size ranged from 14 to 16 F. In the upper limb group, the arterial cannula size ranged from 6 to 8F and the venous cannula size ranged from 10 to 12F. No patient required any homologous blood transfusion postoperatively. No operative death or major complications occurred during the early postoperative period, confirming the safety of this treatment. Both optimal cannula size selection and maintaining perfusion temperature below 41 degrees C were judged to be important in elimination of vascular and deep tissue injury.

Localized Bone Marrow Transplantation Leads to Skin Allograft Acceptance in Nonmyeloablated Recipients: Comparison of Intra‐Bone Marrow and Isolated Limb Perfusion

“…Third, immunoreactivity against third party allografts was preserved, suggesting that acceptance of the skin grafts was mediated by hemopoietic chimerism [1][2][3][4][5], and was not a limited consequence of chemical conditioning. Finally, considering the relative safety of IL [23], IL-BMT may have significant clinical applications for induction of tolerance and treatment of nonmalignant disorders.…”

Isolated limb infusion for local control of lower limb melanoma: Radiologic aspects

“…Isolated limb perfusion is not widely available as it is complex, time‐consuming and costly. A larger catheter size is usually needed, varying up to 14 Fr for the arterial access and from 14 to 16 Fr for venous access 13 …”

Consideraciones perioperatorias en el paciente oncológico sometido a perfusión aislada de la extremidad

“…Se realiza la premedicación con midazolam (1-2 mg) para, posteriormente, realizar la inducción con propofol (1-2 mg/kg), fentanilo (0.5-1 µg/kg) y rocuronio (0.6 mg/kg) para el bloqueo neuromuscular 26 . Otros autores reportan el uso de tiopental y óxido nítrico 45 . Después de la intubación, la anestesia se mantiene con isoflurano, desflurano o sevoflurano con (fracción inspirada de oxígeno) FiO 2 entre 0.5 y 1.0.…”