Annals of Surgical Oncology

, Volume 24, Issue 4, pp 990–997 | Cite as

Standard Clinical Protocol for Bidirectional Hyperthermic Intraperitoneal Chemotherapy (HIPEC): Systemic Leucovorin, 5-Fluorouracil, and Heated Intraperitoneal Oxaliplatin in a Chloride-Containing Carrier Solution

  • Akash M. MehtaEmail author
  • Alwin D. R. Huitema
  • Jacobus W. A. Burger
  • Alexandra R. M. Brandt-Kerkhof
  • Sander F. van den Heuvel
  • Victor J. Verwaal
Gastrointestinal Oncology



Intraperitoneal chemotherapy has an established role in the treatment of selected patients with colorectal peritoneal metastases. Oxaliplatin is highly suitable as a chemotherapeutic agent for hyperthermic intraperitoneal chemotherapy (HIPEC), but its use to date has been limited because of the morbidity caused by severe electrolyte and glycemic imbalances associated with 5% glucose as its carrier solution. This report provides an overview of the development, rationale, and application of intraperitoneal chemotherapy and the use of various drugs and carrier solutions. A novel, evidence-based protocol for bidirectional oxaliplatin-based HIPEC in a physiologic carrier solution (Dianeal PD4 dextrose 1.36%) is presented, and its impact on electrolyte and glucose levels is demonstrated.


After implementation of the new protocol, the serum electrolyte (sodium, potassium, and chloride) levels, glucose levels, and intravenous insulin requirements were intensively measured in eight consecutive cases immediately before HIPEC (T = 0), immediately after HIPEC (T = 30), 1 h after HIPEC (T = 60), and 3 h after HIPEC (T = 180).


The median sodium levels were 140 mmol/L at T = 0, 138 mmol/L at T = 30, 140 mmol/L at T = 60, and 140 mmol/L at T = 180. The respective median potassium levels were 4.6, 4.2, 3.7, and 3.9 mmol/L, and the respective median chloride levels were 112, 111, 111, and 112 mmol/L. The respective median glucose levels were 9, 11.5, 10.7, and 8.6 mmol/L. The median insulin requirements were respectively 0.5, 1.5, 1.2, and 0 U/h. None of the patients were diabetic.


Using a novel protocol for bidirectional oxaliplatin-based HIPEC in Dianeal instead of 5% glucose, the observed fluctuations in this study were minimal and not clinically relevant compared with historical values for electrolyte and glycemic changes using 5% glucose as a HIPEC carrier solution. This novel protocol leads to only minimal and clinically irrelevant electrolyte and glycemic disturbances, and its adoption as the standard protocol for oxaliplatin-based HIPEC should be considered.


Oxaliplatin Peritoneal Carcinomatosis Intraperitoneal Chemotherapy Carrier Solution Peritoneal Cancer Index 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



There are no conflicts of interest.


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Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Akash M. Mehta
    • 1
    Email author
  • Alwin D. R. Huitema
    • 2
  • Jacobus W. A. Burger
    • 3
  • Alexandra R. M. Brandt-Kerkhof
    • 3
  • Sander F. van den Heuvel
    • 4
  • Victor J. Verwaal
    • 5
  1. 1.Department of Surgery, Peritoneal Malignancy InstituteBasingstoke & North Hampshire HospitalBasingstokeUK
  2. 2.Department of Pharmacy and PharmacologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  3. 3.Department of SurgeryErasmus MCRotterdamThe Netherlands
  4. 4.Department of AnaesthesiologyErasmus MCRotterdamThe Netherlands
  5. 5.Department of SurgeryAarhus University HospitalAarhusDenmark

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