TY - JOUR
T1 - Technical considerations for isolated limb perfusion
T2 - A consensus paper
AU - Hayes, Andrew J.
AU - Coker, David J.
AU - Been, Lukas
AU - Boecxstaens, Veerle WSM
AU - Bonvalot, Sylvie
AU - De Cian, Franco
AU - de la Cruz-Merino, Luis
AU - Duarte, Carlos
AU - Eggermont, Alexander
AU - Farricha, Victor
AU - Fiore, Marco
AU - Grünhagen, Dirk
AU - Grützmann, Robert
AU - Honoré, Charles
AU - Jakob, Jens
AU - Hocevar, Marko
AU - van Houdt, Winan
AU - Klauzner, Joseph
AU - Kettelhack, Christoph
AU - Märten, Angela
AU - Martinez-Said, Hector
AU - Matter, Maurice
AU - Michot, Audrey
AU - Niethard, Maya
AU - Pennacchioli, Elisabetta
AU - Podleska, Lars E.
AU - Rabago, Gregorio
AU - Rastrelli, Marco
AU - Reijers, Sophie
AU - Ribeiro, Matilde
AU - Schwarzbach, Matthias
AU - Snow, Hayden A.
AU - Spacek, Miroslav
AU - Stoldt, Stephan
AU - Testori, Alessandro
AU - Zoras, Odysseas
AU - Olofsson Bagge, Roger
N1 - Publisher Copyright:
© 2024 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology
PY - 2024/6
Y1 - 2024/6
N2 - Background: Isolated limb perfusion (ILP) is a well-established surgical procedure for the administration of high dose chemotherapy to a limb for the treatment of advanced extremity malignancy. Although the technique of ILP was first described over 60 years ago, ILP is utilised in relatively few specialist centres, co-located with tertiary or quaternary cancer centres. The combination of high dose cytotoxic chemotherapy and the cytokine tumour necrosis factor alpha (TNFα), mandates leakage monitoring to prevent potentially serious systemic toxicity. Since the procedure is performed at relatively few specialist centres, an ILP working group was formed with the aim of producing technical consensus guidelines for the procedure to streamline practice and to provide guidance for new centres commencing the technique. Methods: Between October 2021 and October 2023 a series of face to face online and hybrid meetings were held in which a modified Delphi process was used to develop a unified consensus document. After each meeting the document was modified and recirculated and then rediscussed at subsequent meeting until a greater than 90% consensus was achieved in all recommendations. Results: The completed consensus document comprised 23 topics in which greater than 90% consensus was achieved, with 83% of recommendations having 100% consensus across all members of the working group. The consensus recommendations covered all areas of the surgical procedure including pre-operative assessment, drug dosing and administration, perfusion parameters, hyperthermia, leakage monitoring and theatre logistics, practical surgical strategies and also post-operative care, response evaluation and staff training.Conclusion: We present the first joint expert-based consensus statement with respect to the technical aspects of ILP that can serve as a reference point for both existing and new centres in providing ILP.
AB - Background: Isolated limb perfusion (ILP) is a well-established surgical procedure for the administration of high dose chemotherapy to a limb for the treatment of advanced extremity malignancy. Although the technique of ILP was first described over 60 years ago, ILP is utilised in relatively few specialist centres, co-located with tertiary or quaternary cancer centres. The combination of high dose cytotoxic chemotherapy and the cytokine tumour necrosis factor alpha (TNFα), mandates leakage monitoring to prevent potentially serious systemic toxicity. Since the procedure is performed at relatively few specialist centres, an ILP working group was formed with the aim of producing technical consensus guidelines for the procedure to streamline practice and to provide guidance for new centres commencing the technique. Methods: Between October 2021 and October 2023 a series of face to face online and hybrid meetings were held in which a modified Delphi process was used to develop a unified consensus document. After each meeting the document was modified and recirculated and then rediscussed at subsequent meeting until a greater than 90% consensus was achieved in all recommendations. Results: The completed consensus document comprised 23 topics in which greater than 90% consensus was achieved, with 83% of recommendations having 100% consensus across all members of the working group. The consensus recommendations covered all areas of the surgical procedure including pre-operative assessment, drug dosing and administration, perfusion parameters, hyperthermia, leakage monitoring and theatre logistics, practical surgical strategies and also post-operative care, response evaluation and staff training.Conclusion: We present the first joint expert-based consensus statement with respect to the technical aspects of ILP that can serve as a reference point for both existing and new centres in providing ILP.
UR - http://www.scopus.com/inward/record.url?scp=85187978710&partnerID=8YFLogxK
U2 - 10.1016/j.ejso.2024.108050
DO - 10.1016/j.ejso.2024.108050
M3 - Review article
C2 - 38498966
AN - SCOPUS:85187978710
SN - 0748-7983
VL - 50
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 6
M1 - 108050
ER -