Journal of Surgical Oncology 2011;103:6–89 Evaluation of Environmental Contamination by Platinum and Exposure Risks for Healthcare Workers During a Heated Intraperitoneal Perioperative Chemotherapy (HIPEC) Procedure ARMANDE KONATE, MD, 1 JOE ¨ L POUPON, MD, PhD, 2 ANTOINE VILLA, MD, PhD, 3 ROBERT GARNIER, MD, 3 HE ´ LE ` NE HASNI-PICHARD, MD, 4 DANIELLE MEZZAROBA, 5 GABRIEL FERNANDEZ, MD, 6 AND MARC POCARD, MD, PhD 1 * 1 Service de Chirurgie Digestive, Ho ˆ pital Lariboisie `re-AP-HP & Universite ´ Paris-Diderot/Paris 7, Ho ˆ pital Lariboisie `re-AP-HP 2 rue Amboise Pare ´, Paris, France 2 Laboratory of Toxicology, Ho ˆ pital Lariboisie `re-AP-HP & Universite ´ Paris-Diderot/Paris 7, Ho ˆ pital Lariboisie `re-AP-HP 2 rue Amboise Pare ´, Paris, France 3 Paris Poison Centre, Occupational and Environmental Health Consultation Service, Ho ˆ pital Fernand Widal AP-HP and Universite ´ Paris-Diderot/Paris 7, Ho ˆ pital Lariboisie `re-AP-HP 2 rue Amboise Pare ´, Paris, France 4 CRAMIF, Paris Cedex 19, France 5 Logistic Directorate and Work, Ho ˆ pital Lariboisie `re-AP-HP 2 rue Amboise Pare ´, Paris, France 6 Occupational Medicine, Ho ˆ pital La-Pitie ´-Salpetrie `re AP-HP 47-83 Boulevard de l’Ho ˆ pital, Paris, France The study was plan to assess platinum (Pt) contamination in the operating room and its exposure to health workers during heated intraperitoneal perioperative chemotherapy (HIPEC) using oxaliplatin. Materials and Methods: Pt was measured in urinary and environmental (air and surfaces) samples via inductively coupled plasma mass spectrometry (ICP-MS). Urinary samples were obtained from 11 members of the staff before and after the procedure and from 6 controls. Samples from 15 surfaces and from 3 filters from the air extractors were also analyzed for Pt contamination. Results: Before HIPEC, Pt levels in urinary samples were similar in both the exposed and control groups; concentrations were below the limit of detection (i.e., 1.5 ng/L). No elevation was observed in the exposed group at the end of the procedure. Surgeon gloves were heavily contaminated. On other analyzed surfaces, lesser amounts of Pt were measured, ranging from 2 ng on the surgeon’s hands to 183 ng on the forceps. All three air filters tested negative. Conclusion: No contamination of healthcare workers or of the air in the operating room was detected. However, the heavy contamination of the surgeon’s gloves demonstrates why doubling of specialized gloves for the surgeon should be mandatory. J. Surg. Oncol. 2011;103:6–89. ß 2010 Wiley-Liss, Inc. KEY WORDS: HIPEC; carcinomatosis; oxaliplatin INTRODUCTION Oxaliplatin was first introduced in the clinical setting as part of a combination therapy with 5-fluorouracil/folinic acid (5-FU/FA) in an attempt to improve the response rate obtained with 5-FU/FA in colorectal cancer [1]. Currently, oxaliplatin is considered a primary treatment option for colorectal cancer. Peritoneal carcinomatosis is a common manifestation of digestive tract cancer that has been regarded as a terminal disease with a short median survival. Over the past decade, a new loco-regional therapeutic approach that combines cytoreductive surgery with heated intraperitoneal perioperative chemotherapy (HIPEC) was proposed. HIPEC used with cytoreductive surgery appears to be an effective therapeutic approach in carefully selected patients and offers a chance for a cure or the palliation of this condition, which has few alternate treatment options [2]. The first publication concerning oxaliplatin use for carcinomatosis treatment and its intraperitoneal administration was reported in 2002 [3]. Intraperitoneal oxaliplatin administration allows for high perito- neal and tumor concentrations with limited systemic absorption and thus was proposed for use in HIPEC treatment. This new modality of treatment, when restricted to highly selected patients, has given encouraging preliminary results, with a promising 3-year survival rate of 65% in a pilot study [4]. However, using a new technology such as the HIPEC procedure in a surgical theatre can induce new risks. The risk of systemic contamination of the hospital staff through inhalation or hand-to- mouth activity during the HIPEC procedure deserves evaluation. The only research regarding this potential toxicity was an experimental study by Guerbet et al. in 2007 [5]. As HIPEC improves patient survival and also becomes a gold standard, the risks of the medical staff during this procedure should be more realistically evaluated. There- fore, we conducted a specific study in the surgical theatre to explore the possibility of exposure to oxaliplatin through inhalation and/or contact with contaminated surfaces during the HIPEC procedure. MATERIALS AND METHODOLOGY HIPEC Procedure The procedure was performed as previously reported [3]. Briefly, the abdomen was opened using a technique called ‘‘coliseum,’’ and the abdominal cavity was infused with 2 L/m 2 of the chemotherapeutic *Correspondence to: Marc Pocard, Service de Chirurgie Digestive, Assistance Publique des Ho ˆpitaux de Paris, Ho ˆpital Lariboisie `re 2 rue Amboise Pare ´, 75010 Paris, France. Fax: 33-1-42-11-52-13. E-mail: marc.pocard@lrb.aphp.fr Received 27 July 2010; Accepted 11 August 2010 DOI 10.1002/jso.21740 Published online 30 September 2010 in Wiley Online Library (wileyonlinelibrary.com). ß 2010 Wiley-Liss, Inc.