Techniques of delivering hyperthermic intraperitoneal chemotherapy

Hyperthermic intraperitoneal chemotherapy (HIPEC) was first delivered to a human in 1979 by Dr. John Spratt at the University of Louisville when he treated a male patient with pseudomyxoma peritonei (1). In collaboration with other researchers, he developed a delivery system using a "closed" technique, with both the fascia and skin closed. Since that time, there has been increasing interest around the world in the delivery of HIPEC. The most widely used methods have involved perioperative perfusion of chemotherapy in heated perfusate performed at the time of open laparotomy (see the following sections), but delivery of HIPEC has also been reported with laparoscopic placement of inflow and outflow tubing (2) and regional (3) and whole-body hyperthermia (4). Hyperthermic intraperitoneal chemotherapy requires an organized team within the operating room who all understand their roles. The anesthesiologist manages the cooling of the patient's core temperature before the hyperthermic perfusion and monitors the patient's vital parameters, particularly the core temperature, during the perfusion. The perfusionist, often recruited from cardiac surgery because of experience with the techniques of cardiopulmonary bypass, operates the heat exchange pump and equipment for the perfusion. Although it is everyone's responsibility, the scrub technicians and circulating nurses are charged with the specific duty of ensuring proper adherence to operating room protocol for the use of hazardous agents. The two main techniques for hyperthermic IP perfusion are "open," where the incision is open during the HIPEC, and "closed" where the abdominal skin and/or fascia are closed. Both basic methods have been extensively utilized, with many individual variations. In this chapter, the most widely used open technique, the "Coliseum," and the closed technique will be described and discussed.