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Occupational safety of pressurized intraperitoneal aerosol chemotherapy (PIPAC)

Wouter Willaert, Paul Sessink and Wim Ceelen UGent (2017) PLEURA AND PERITONEUM. 2(3). p.121-128
abstract
Background: Pressurized intraperitoneal aerosol chemotherapy (PIPAC) has emerged as a novel method to treat extensive, small volume peritoneal metastases. The clinical use of chemotherapy containing aerosols represents a potential occupational health hazard. We report the results of toxicological analysis during the first two clinical PIPAC procedures performed at Ghent University Hospital. Methods: After extensive preparation and in vitro testing, two patients were treated with PIPAC: the first using doxorubicin (2.86 mg in 51.43 mL) and cisplatin (14.28 mg in 164.3 mL), the second using oxaliplatin (182.10 mg in 186.42 mL). A standardized safety checklist was developed and used. Aerosol delivery was combined with electrostatic precipitation (ePIPAC). The following samples were obtained at several time points and locations: environmental air, floor surface wipes, surgeon's gloves, surgeon's hand wipes, circuit filters, and fluid from the water seal collection chamber container placed along the closed aerosol waste evacuating line. Platinum concentration was measured in these samples using voltammetry. Sample collection and analysis were performed by an independent external laboratory. Results: Platinum was not detected on the four floor locations after both procedures (detection limit 0.02 ng/cm(2)). Similarly, no platinum was detected in environmental air during both PIPACs at the surgeon's or anesthesiologist's position (detection limit 4.0-27 ng/m(3)). No platinum contamination was detected on the hands, outer pair of gloves, or inner pair of gloves of the surgeon (detection limit 70 and 50 ng respectively). Platinum was not detected on the filters and in the air-seal container liquid. Conclusions: With adequate preparation and precautions, a clinical PIPAC program can be established without measurable chemotherapy exposure to the operating room environment or healthcare workers.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
carcinomatosis, occupational, PIPAC, PERITONEAL CARCINOMATOSIS, ELECTROSTATIC PRECIPITATION, CYTOREDUCTIVE SURGERY, COLORECTAL-CANCER, OXALIPLATIN, EXPOSURE, HEALTH, EPIPAC, HIPEC
journal title
PLEURA AND PERITONEUM
Pleura Peritoneum
volume
2
issue
3
pages
121 - 128
ISSN
2364-7671
2364-768X
DOI
10.1515/pp-2017-0018
language
English
UGent publication?
yes
classification
A2
copyright statement
I have transferred the copyright for this publication to the publisher
id
8549890
handle
http://hdl.handle.net/1854/LU-8549890
date created
2018-02-13 11:58:15
date last changed
2018-05-03 10:35:58
@article{8549890,
  abstract     = {Background: Pressurized intraperitoneal aerosol chemotherapy (PIPAC) has emerged as a novel method to treat extensive, small volume peritoneal metastases. The clinical use of chemotherapy containing aerosols represents a potential occupational health hazard. We report the results of toxicological analysis during the first two clinical PIPAC procedures performed at Ghent University Hospital. 
Methods: After extensive preparation and in vitro testing, two patients were treated with PIPAC: the first using doxorubicin (2.86 mg in 51.43 mL) and cisplatin (14.28 mg in 164.3 mL), the second using oxaliplatin (182.10 mg in 186.42 mL). A standardized safety checklist was developed and used. Aerosol delivery was combined with electrostatic precipitation (ePIPAC). The following samples were obtained at several time points and locations: environmental air, floor surface wipes, surgeon's gloves, surgeon's hand wipes, circuit filters, and fluid from the water seal collection chamber container placed along the closed aerosol waste evacuating line. Platinum concentration was measured in these samples using voltammetry. Sample collection and analysis were performed by an independent external laboratory. 
Results: Platinum was not detected on the four floor locations after both procedures (detection limit 0.02 ng/cm(2)). Similarly, no platinum was detected in environmental air during both PIPACs at the surgeon's or anesthesiologist's position (detection limit 4.0-27 ng/m(3)). No platinum contamination was detected on the hands, outer pair of gloves, or inner pair of gloves of the surgeon (detection limit 70 and 50 ng respectively). Platinum was not detected on the filters and in the air-seal container liquid. 
Conclusions: With adequate preparation and precautions, a clinical PIPAC program can be established without measurable chemotherapy exposure to the operating room environment or healthcare workers.},
  author       = {Willaert, Wouter and Sessink, Paul and Ceelen, Wim},
  issn         = {2364-7671},
  journal      = {PLEURA AND PERITONEUM},
  keyword      = {carcinomatosis,occupational,PIPAC,PERITONEAL CARCINOMATOSIS,ELECTROSTATIC PRECIPITATION,CYTOREDUCTIVE SURGERY,COLORECTAL-CANCER,OXALIPLATIN,EXPOSURE,HEALTH,EPIPAC,HIPEC},
  language     = {eng},
  number       = {3},
  pages        = {121--128},
  title        = {Occupational safety of pressurized intraperitoneal aerosol chemotherapy (PIPAC)},
  url          = {http://dx.doi.org/10.1515/pp-2017-0018},
  volume       = {2},
  year         = {2017},
}

Chicago
Willaert, Wouter, Paul Sessink, and Wim Ceelen. 2017. “Occupational Safety of Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC).” Pleura and Peritoneum 2 (3): 121–128.
APA
Willaert, Wouter, Sessink, P., & Ceelen, W. (2017). Occupational safety of pressurized intraperitoneal aerosol chemotherapy (PIPAC). PLEURA AND PERITONEUM, 2(3), 121–128.
Vancouver
1.
Willaert W, Sessink P, Ceelen W. Occupational safety of pressurized intraperitoneal aerosol chemotherapy (PIPAC). PLEURA AND PERITONEUM. 2017;2(3):121–8.
MLA
Willaert, Wouter, Paul Sessink, and Wim Ceelen. “Occupational Safety of Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC).” PLEURA AND PERITONEUM 2.3 (2017): 121–128. Print.