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Is Platinum Present in Blood and Urine from Treatment Givers during Hyperthermic Intraperitoneal Chemotherapy?
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine. (Eva Vingård)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
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2010 (English)In: Journal of oncology, ISSN 1687-8469, Vol. 2010, 649719- p.Article in journal (Refereed) Published
Abstract [en]

Background. In selected patients with peritoneal carcinomatosis (PC) originating from colorectal cancer (CRC) the high dosage of oxaliplatin (460 mg/m(2)) is recommended for hyperthermic intraperitoneal chemotherapy (HIPEC), which may be a health risk to those administering the drug. The aim of this study was to determine the risk of platinum (Pt) exposure for the two main people handling and administering the cytotoxic agent during HIPEC. Methods. Samples of blood and urine were collected from one male surgeon and one female perfusionist during oxaliplatin-based HIPEC treatment with open abdomen coliseum technique on six consecutive patients with PC from CRC. Results. All blood samples analysed were below the detection limit of <0.05 nmol/L Pt, and the urine samples were all below the detection limit of <0.03 nmol/L Pt. Conclusions. There appears to be little or no risk of Pt exposure during HIPEC when the recommended protective garment is used and the safety considerations are followed.

Place, publisher, year, edition, pages
2010. Vol. 2010, 649719- p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-151593DOI: 10.1155/2010/649719PubMedID: 20631909OAI: oai:DiVA.org:uu-151593DiVA: diva2:410643
Available from: 2011-04-14 Created: 2011-04-14 Last updated: 2012-05-11Bibliographically approved
In thesis
1. Work Environment in the Operating Room during Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Factors Influencing Choice of Protective Equipment
Open this publication in new window or tab >>Work Environment in the Operating Room during Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Factors Influencing Choice of Protective Equipment
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Peritoneal carcinomatosis (PC) is a common metastatic manifestation of both gastrointestinal and gynecological malignancies. Curative modes of treatment are cytoreductive surgery (CRS) combined with intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC). Surgeons and operating room (OR) staff attending these procedures are exposed to chemotherapy and electrocautery smoke. Heated chemotherapy (HIPEC) may vaporize and become inhaled by those administering it and, moreover, large quantities of electrocautery smoke may also be inhaled by surgeons and OR staff, with unknown adverse health effects. The general aim of this thesis was to investigate the work environment during major abdominal surgery and HIPEC, and to map the factors influencing the behavior of OR nurses and surgeons when choosing protective equipment against electrocautery smoke.

To determine the presence of platinum, a total of 36 blood and 36 urine samples were collected from one surgeon and one perfusionist during six oxaliplatin-based HIPEC treatments (Paper I). Regarding electrocautery smoke, amounts of ultrafine particles (UFPs) in the smoke from 14 CRS procedures and 11 colorectal cancer (CRC) procedures were collected and compared (Paper II). Additionally, polycyclic aromatic hydrocarbons (PAHs) were identified and quantified in electrocautery smoke during 40 CRS procedures (Paper III). Lastly, seven OR nurses and seven surgeons were interviewed individually to explore what factors influenced their behavior when choosing protective equipment against electrocautery smoke. The transcribed texts were analyzed with qualitative content analysis (Paper IV).

All blood and urine samples were below the detection limit (Paper I). The amount of UFPs produced during CRS procedures was significantly higher than from CRC procedures (Paper II), and PAHs never exceeded Swedish occupational exposure limits (OELs) (Paper III). OR nurses and surgeons had a knowledge of electrocautery smoke and were aware of risks. However, external factors governed the use of protective equipment against electrocautery smoke (Paper IV).

HIPEC with oxaliplatin seems to present no risk for treatment givers. However, the possible risks from exposure of cumulative amounts of UFPs and PAHs are still unknown. OR nurses’ and surgeons’ knowledge about the possible risks of electrocautery smoke, and the use of protective equipment, are therefore important.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2011. 85 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 716
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-159945 (URN)978-91-554-8196-4 (ISBN)
Public defence
2011-12-16, Auditorium Minus, Gustavianum, Akademigatan 3, Uppsala, 13:15 (Swedish)
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Supervisors
Available from: 2011-11-24 Created: 2011-10-12 Last updated: 2012-01-03

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Näslund Andréasson, SaraAnundi, HelenaMahteme, Haile

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