Is the blood of a surgeon performing HIPEC contaminated by irinotecan, its major metabolites and platinum compounds?

Abstract

Objectives Hyperthermic intraperitoneal chemotherapy (HIPEC) is a beneficial surgical technique for patients, but the surgeons are being exposed to cytotoxic drugs. Few biomonitoring studies were led on blood samples in the context of HIPEC. This study aimed to evaluate the surgeon’s plasmatic and red blood cell (RBC) contamination by irinotecan, two of its major metabolites and platinum compounds. Methods HIPEC procedures performed using the coliseum techniques were observed between September 2015 and April 2018 in a French comprehensive cancer center. Irinotecan and its metabolites SN-38 and APC were dosed by UHPLC with a limit of quantification determined at 50 pg/mL. Platinum compounds were dosed by inductively coupled plasma mass spectrometry with a limit of quantification determined at 16 pg/mL. Results Despite collective and personal protective equipment, 80% of plasma samples were contaminated by irinotecan and 33% by platinum compounds out of 21. The results showed that the surgeon was contaminated after HIPEC and even after a period of HIPEC inactivity. Nineteen percent of plasmatic samples and 45% of RBC samples were contaminated by SN-38, the active metabolite of irinotecan. APC was only found in some RBC samples (33%). Conclusions Even if this study shows blood contamination by irinotecan, two of its major metabolites (including active SN-38) and platinum compounds both in the plasma and RBC of a surgeon performing the HIPEC procedures, further studies should be performed to confirm these results. Additional studies should be carried out to further investigate the contamination in the context of HIPEC and more broadly in the hospital.

Exposure to Antineoplastic Drugs in Occupational Settings: A Systematic Review of Biological Monitoring Data

“…Nevertheless, environmental contamination could be detected in various locations in the operating rooms, including gloves, hands, devices, and floor. In a more recent study, Saint-Lorant et al [ 28 ] demonstrated a Pt contamination in 36% (7 out of 19) of plasma samples collected from a French surgeon engaged in 17 HIPEC procedures for a period of 3 years.…”

“…When the IRT contamination was investigated in a surgeon exposed during HIPEC procedures [ 28 ], despite collective and PPE, 79% and 63% of plasma and red blood cell samples were contaminated, both soon after HIPEC procedures, as well as following a period of inactivity.…”

“…Overall, this prevents extrapolation into definite conclusions on qualitative and quantitative types of exposure per job category or suitable comparisons and needs to be overcome in future investigations. Moreover, the increasing application of ADs in innovative surgical procedures, such as the HIPEC and PIPAC, as well as the employment of such drugs also for non-malignant diseases, may increase the likelihood for healthcare occupational exposure [ 28 , 36 , 42 ]. Particularly, the exposure for healthcare workers to ADs during open abdomen HIPEC is a subject of concern since healthcare workers in the operating room generally have no experience in handling these drugs.…”

Hipertermik İntraperitoneal Kemoterapi Uygulaması: Çalışan Güvenliği

“…Bu nedenle bu tekniğin kullanımı söz konusu ise teması önleyecek koruyucu ekipman kullanımının gerekli olduğunu bildirmişlerdir (17). Ancak Lorent ve ark (2021) açık teknik HİPEK uygulamasında özel kişisel koruyucu ekipman (PVC su geçirmez botlar, cerrahi önlük, FFP3 maske ve 2 çift neopren 1 çift lateks cerrahi eldiven) kullanımına rağmen cerrahların kan örneklerinde irinotekan ve platin saptamıştır (18). Açık teknikte cerrahi ekibin kemoterapötik ajanlar ile dermal yoldan maruziyet riskinin oldukça yüksek olduğu sonucuna varılmıştır.…”

Knowledge and practices about safe handling regarding the risk of exposure to antineoplastic drugs for caregivers in compounding units and in operating rooms performing HIPEC/PIPAC

“…Therefore, even though the OR and CU are considered to be quite different from several points of view, blood contamination by ADs has been detected in caregivers attached to both locations. 27–29…”