Can increased intraabdominal pressure augment the cytotoxicity of intraperitoneal chemotherapy during HIPEC? A systematic review.

The utility of increased intraabdominal pressure to increase the efficacy of intraperitoneal was studied. All relevant studies published between 1996 and April of 2025 were reviewed. Six manuscripts from five different institutions were included for appraisal and data extraction. There was a single randomized trial in humans with all other data from rat or pig experiments. The pharmacokinetics of diffusion were determined to be unchanged by increased pressure. In all studies, the concentration of chemotherapy as it moved from the peritoneal space to the body compartment through the peritoneal-plasma barrier was regarded as a surrogate for cytotoxicity. At the completion of HIPEC, large differences in chemotherapy concentration when parietal peritoneum was compared to visceral peritoneum were reported in 4 of 6 studies. Four studies reported increased chemotherapy concentration in parietal peritoneal tissues with increased pressure, and 4 studies reported a small increase in chemotherapy concentration in visceral peritoneal tissues. Increased chemotherapy concentrations in peritoneal tissues caused by large volumes of chemotherapy infused into the peritoneal space can be the result of increased tissue concentrations from increased volume unrelated to increased pressure. A hypothesis to assist in data interpretation suggests that pressure increased the concentration of chemotherapy within the parietal peritoneal plasma barrier by expanding the permeability area. The increase in chemotherapy concentration in parietal peritoneal tissues was estimated at times 1.4 to 3.5. Visceral peritoneal tissues cannot be expanded by pressure so that little, if any, increased concentration of chemotherapy by pressure in these tissues was reported.