Toxicity and morbility after isolated lower limb perfusion in 242 chemo-hyperthermal treatments for cutaneous melanoma: The experience of the Tuscan Reference Centre

Pace, M; Gattai, Riccardo; Matteini, Maria; Mascitelli, E.; Bechi, Paolo

doi:10.1186/1756-9966-27-67

Cited by 11 publications

(17 citation statements)

References 21 publications

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“…In the 1980s, Wieberdink et al described a grading scale (I-V) for toxicity associated with limb perfusion [13]. Based on larger published series, mild erythema or edema (Grade I-II) is seen in most patients [22,23]; our experience was similar. Higher grade toxicity requiring fasciotomy (for compartment syndrome) or amputation (for tissue loss) has been reported to occur in up to 1-2% of patients undergoing HILP [21,22,24].…”

Section: Discussionsupporting

confidence: 58%

Anesthesia management of patients undergoing hyperthermic isolated limb perfusion with melphalan for melanoma treatment: an analysis of 17 cases

et al. 2013

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BackgroundHyperthermic isolated limb perfusion (HILP) is used for patients with intractable or extensive in-transit metastatic melanoma of the limb to deliver high concentrations of cytotoxic agents to the affected limb and offers a treatment option in a disease stage with a poor prognosis when no treatment is given.MethodsIn a retrospective chart review of 17 cases, we studied the anesthetic and hemodynamic changes during HILP and its management.ResultsHILP was well tolerated except in one case that is described herein. We present summary data of all cases undergoing upper and lower limb perfusion, discuss our current clinical practice of preoperative, perioperative and intraoperative patient care including the management of HILP circuit.ConclusionHILP is a challenging procedure, and requires a team effort including the surgical team, anesthesia care providers, perfusionists and nurses. Intraoperatively, invasive hemodynamic and metabolic monitoring is indispensable to manage significant hemodynamic and metabolic changes due to fluid shifts and release of cytokines.

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Section: Discussionsupporting

confidence: 58%

Anesthesia management of patients undergoing hyperthermic isolated limb perfusion with melphalan for melanoma treatment: an analysis of 17 cases

et al. 2013

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“…Performing a prophylactic closed fasciotomy of the anterior compartment of the leg or of the ventral and dorsal compartments of the forearm has been suggested in order to prevent the development of compartmental syndrome; however, given that the incidence of this complication is lower than 5% [36][37][38][39] , the procedure can be carried out if postoperative clinical evolution warrants it, or if an increase in intracompartmental pressure directly measured through a monitor is reported 40 .…”

Section: Methodsmentioning

confidence: 99%

Perioperative considerations in the oncologic patient undergoing isolated limb perfusion

Cuéllar-Guzmán¹,

Ferretiz-López²,

Cárdenas-Herrera³

2022

GAMO

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Isolated limb perfusion (ILP) and hyperthermic ILP (HILP) are therapeutic options for patients with unresectable malignancies in the extremities (e.g., primarily melanoma and soft tissue tumors), they induce a high rate of tumor response; associates with high limb salvage rates and represents an effective alternative to amputation. These are challenging procedures with a high technical difficulty that require the efforts of a multidisciplinary team (surgeon, anesthesiologist, nurse, perfusionist and intensivist). Hemodynamic changes, drug leakage through collateral vessels, local and systemic toxicity, and potential complications require continuous and invasive monitoring during the procedure and rigorous post-surgical monitoring. The purpose of this review article was to update the strategies for the perioperative care of cancer patients undergoing this procedure.

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“…Posteriormente se reparan los vasos sanguíneos para restablecer el flujo sanguíneo hacia la extremidad 32 . Se ha sugerido la realización de una fasciotomía cerrada profiláctica del compartimento anterior de la pierna o de los compartimentos dorsal y ventral del antebrazo para prevenir el desarrollo de síndrome compartimental; sin embargo, dado que la incidencia de esta complicación es inferior al 5% [36][37][38][39] , el procedimiento puede realizarse si la evolución clí-nica postoperatoria lo amerita o si se reporta un incremento en la presión intracompartimental medida directamente través de un monitor 40 .…”

Section: Procedimientounclassified

“…Las primeras fueron clasificadas por Wieberdink, et al en 1982 en una escala de cinco grados, la cual se utiliza de forma estandarizada desde entonces (Tabla 2) 47 . En la mayoría de los estudios se reporta un predominio de la toxicidad grado I (sin reacción) y grado II (eritema y edema leve), con una incidencia que oscila entre el 32 y el 100%, mientras que la toxicidad grado III ocurre en menor frecuencia (1 al 19%) 36,37,[48][49][50][51][52][53] . La toxicidad de alto grado que requiere manejo con fasciotomía para el síndrome compartimental (grado IV) o amputación para la pérdida tisular y necrosis (grado V) se ha reportado en el 1-2% de los pacientes 37,54,55 .…”

Section: Complicaciones Postoperatoriasunclassified

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

Cuéllar-Guzmán¹,

Ferretiz-López²,

Cárdenas-Herrera³

2022

GAMO

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Gaceta Mexicana de Oncologia. 2017;16(5):289-294 Resumen La perfusión aislada de la extremidad (PAE) y la perfusión hipertérmica aislada de la extremidad (PHAE) son procedimientos utilizados para el tratamiento de diversos tumores localizados en las extremidades (primordialmente melanoma y tumores de tejidos blandos), inducen una elevada tasa de respuesta tumoral y se asocian a una elevada tasa de salvamento de la extremidad, representando una alternativa a la amputación. Se trata de procedimientos complejos y con una elevada dificultad técnica que requieren del esfuerzo de todo un equipo multidisciplinario (cirujano, anestesiólogo, enfermera, perfusionista e intensivista). Los cambios hemodinámicos, la fuga de los fármacos a través de vasos colaterales, su toxicidad local y sistémica, así como las potenciales complicaciones, requieren de la monitorización continua e invasiva durante el procedimiento y de una estrecha vigilancia posquirúrgica. El propósito de este artículo de revisión fue analizar las pautas para el abordaje perioperatorio del paciente oncológico que se somete a este procedimiento. (creativecommons.org/licenses/by-nc-nd/4.0/). abstract Isolated limb perfusion (ILP) and hyperthermic ILP (HILP) are therapeutic options for patients with unresectable malignancies in the extremities (e.g. primarily melanoma and soft tissue tumors), they induce a high rate of tumor response; associates with high limb salvage rates and represents an effective alternative to amputation. These are challenging procedures with a high technical difficulty that require the efforts of a multidisciplinary team (surgeon, anesthesiologist, nurse, perfusionist and intensivist). Hemodynamic changes, drug leakage through collateral vessels, local and systemic toxicity, and potential complications require continuous and invasive monitoring during the procedure and rigorous post-surgical monitoring. The purpose of this review article was to update the strategies for the perioperative care of cancer patients undergoing this procedure.

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Toxicity and morbility after isolated lower limb perfusion in 242 chemo-hyperthermal treatments for cutaneous melanoma: The experience of the Tuscan Reference Centre

Abstract: Background: The aim of this retrospective study was to assess the results concerning the regional and systemic toxicity and complications in 242 chemo-hyperthermal treatments (HILPs) for lower limb melanoma.

Cited by 11 publications

References 21 publications

Anesthesia management of patients undergoing hyperthermic isolated limb perfusion with melphalan for melanoma treatment: an analysis of 17 cases

Anesthesia management of patients undergoing hyperthermic isolated limb perfusion with melphalan for melanoma treatment: an analysis of 17 cases

Perioperative considerations in the oncologic patient undergoing isolated limb perfusion

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

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