Regional perfusion of pelvis and abdomen by an indirect technique

Abstract

R is applicable to many anatomic areas of the body, but few regions can present as many opportunities for this experimental treatment method as does the pelvis. Pelvic cancers that are advanced beyond suitability for any form of surgical treatment often remain localized to this region. Many reports have described experience with clinical perfusion of the pelvis using the method Creech et a1.2 described in their original report. This procedure entails abdominal operation with direct control of the lumbar aorta and vena cava and is associated with considerable leakage. The purpose of this report is to present our experience with an indirect technique for pelvic perfusion that effects improved isolation of this regional area and also obviates intra-abdominal surgery. Related procedures utilizing this indirect approach will also be described. In all regional perfusion circuits, the degree of vascular isolation that is achieved is dependent on a tourniquet to control blood flow through collateral channels. Conventional techniques for pelvic perfusion has been asso- ciated with limited isolation due to the absence of a cephalad tourniquet. Although the aorta and vena cava are occluded at laparotomy, leakage studies with intravascular isotopes always show rapid mixing between the perfusion and systemic circuits. Although regional localization of the Chemotherapeutic agent occurs to a greater degree than studies with radioactive chromium (C*l)-labeled erythrocytes or radio iodinated serum albumin (RISA) suggest, systemic toxicity from leakage limits the dosage of some agents.5 T h i s effect is minimized with so-called short-acting agents that rapidly clisappear from the vascular compartment by