Early Postop IP Chemo

Intraperitoneal chemotherapy following complete cytoreduction in patients with appendiceal, colonic, rectal, gastric, or other gastrointestinal adenocarcinomas has utilized early postoperative intraperitoneal 5-fluorouracil. In pretreated ovarian cancer patients who have neurologic toxicities from systemic cisplatin, additional cisplatin should not be used. These patients are also treated with 5-fluorouracil.

The standardized orders for early postoperative administration of intraperitoneal 5-fluorouracil are shown in Table 7.

TABLE 7

Early postoperative intraperitoneal chemotherapy with 5-fluorouracil

Postoperative Days 1-5

Add to _____ ml 1.5% dextrose peritoneal dialysis solution:
(a) _____ mg 5-fluorouracil (650 mg/m², maximum dose 1300 mg)
(b) 50 mEq sodium bicarbonate.
Intraperitoneal fluid volume:
1 liter for patients < 2.0m², 1.5 liter for > 2.0 m².
Drain all fluid from the abdominal cavity prior to instillation; then clamp all drains.
Run the chemotherapy solution into the abdominal cavity through the Tenckhoff
catheter as rapidly as possible.
Dwell for 23 hours and drain for 1 hour prior to next instillation.
Use gravity to maximize intraperitoneal distribution of the 5-fluorouracil.
Instill the chemotherapy with the patient in a full right lateral position.
After 1/2 hour, direct the patient to turn to the full left lateral position.
Change position right to left every 1/2 hour. If tolerated, use 10 degrees
of Trendelenburg position. Continue turning for the first 6 hours after
instillation of chemotherapy solution.
Continue to drain abdominal cavity after final dwell until Tenckhoff catheter is removed.
Use 33% dose reduction for heavy prior chemotherapy, age greater than 60, or prior radiotherapy.