Immediate postoperative effects of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy using carboplatin on peritoneal tissue inflammatory and ischemic responses: an explorative porcine study

Objectives

This explorative porcine study investigated the immediate postoperative response of inflammatory protein markers and ischemic metabolites in peritoneal abdominal wall tissue during and after hyperthermic intraperitoneal chemotherapy (HIPEC) assessed by microdialysis.

Methods

Eight cancer-free female pigs underwent imitation cytoreductive surgery (CRS) followed by HIPEC (90 min) using a carboplatin dosage of 800 mg/m². A subperitoneal microdialysis catheter was placed in the abdominal wall to sample inflammatory protein markers and ischemic metabolites. During and after HIPEC, dialysates and blood samples were collected over 8 h. Inflammatory protein expression levels were quantified using Proximity Extension Assay (Olink Target 96 Inflammation panel). In addition, concentrations of ischemic metabolites were quantified using a CMA600 microdialysis analyzer.

Results

An immediate response of 27 proteins, including proteins from the TNF family, early inflammatory chemokines, pro- and anti-inflammatory proteins, was found within the first 30 min after HIPEC initiation. This was followed by a modest and relatively constant inflammatory response. Glycerol concentrations tended to decrease during the sampling period, while glucose showed more stable levels. Constant hyperlactatemia exceeding the plasma levels was seen during and after HIPEC, with no significant tissue ischemia as indicated by the lactate/pyruvate ratios.

Conclusions

In a porcine model, CRS with HIPEC leads to an immediate and relatively constant increased inflammatory and ischemic peritoneal tissue short-time response. The explorative findings contribute to the debate on the value of HIPEC in combination with CRS and call for future studies to further investigate the inflammatory and metabolic tissue responses.