In-vivo thermodynamic exploration of gas-based intraperitoneal hyperthermia

Agata Diakun; Tanja Khosrawipour; Agata Mikolajczyk-Martinez; Piotr Kuropka; Jakub Nicpoń; Zdzisław Kiełbowicz; Przemysław Prządka; Bartłomiej Liszka; Shiri Li; Hien Lau; Wojciech Kielan; Veria Khosrawipour

doi:10.3389/fonc.2022.925724

In-vivo thermodynamic exploration of gas-based intraperitoneal hyperthermia

Front Oncol. 2022 Aug 29:12:925724. doi: 10.3389/fonc.2022.925724. eCollection 2022.

Authors

Affiliations

¹ 2nd Department of General Surgery and Surgical Oncology, Wroclaw Medical University, Wroclaw, Poland.
² Department of Surgery (A), University-Hospital Düsseldorf, Heinrich-Heine University, Düsseldorf, Germany.
³ Department of Biochemistry and Molecular Biology, Faculty of Veterinary Sciences, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland.
⁴ Department of Biostructure and Animal Physiology, Wroclaw University, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland.
⁵ Department of Surgery, Faculty of Veterinary Sciences, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland.
⁶ Division of Colon and Rectal Surgery, Department of Surgery, New York Presbyterian Hospital- Weill Cornell College of Medicine, New York, NY, United States.
⁷ Department of Surgery, University of California, Irvine, CA, United States.
⁸ Department of Surgery, Petrus-Hospital Wuppertal, Wuppertal, Germany.

Abstract

Background: While hyperthermic intraperitoneal (i.p) applications are highly efficient in treating peritoneal metastases (PM), they are currently limited to temperatures of 41 - 43° Celsius (C). First data on gas-based i.p. hyperthermia is promising, as this novel method allows a significant temperature rise in superficial peritoneal layers without increasing core temperatures. Until now, key mechanisms of this novel tool, e.g. thermodynamic energy transfer, have not been investigated. This study aims to explore the volume of thermodynamic energy transfer during gas-based i.p. hyperthermia at 48-50°C and its peritoneal effects.

Methods: For this study, three swine were subjected to gas-based i.p. hyperthermia at varying temperatures (48°, 49° and 50°C) in a diagnostic laparoscopy setting with a high-flow air stream. Temperatures of the i.p. cavity, in- and outflow airstream at the trocar were measured and the thermodynamic energy transfer was calculated. Tissue samples were collected on postoperative day 7 for histopathologic analyses.

Results: According to our data, temperatures within the intraabdominal cavity and at the outflow site remain relatively stable at < 40°C. An increase in thermodynamic energy transfer is observed with increasing applied temperatures. Gas-based i.p. hyperthermia induced capillary coagulation and white blood cell infiltration within peritoneal layers.

Conclusions: Gas-based i.p. hyperthermia is an innovative approach which enables the i.p. delivery of specific amounts of thermodynamic energy. Following this procedure, our data indicate remarkable histologic changes on the superficial peritoneal layer most likely attributable to the applied thermodynamic energy. Further studies are required to investigate how these findings can be applied in PM management.

Keywords: Hyperthermia; chemotherapy; colorectal cancer; intraperitoneal; peritoneal metastases; thermodynamics.