Preconditioning with hyperbaric oxygen in pancreaticoduodenectomy:
a randomized, double-blind pilot study
A. Casarotto#*MD; G. Bosco€ MD; E. Nasole$ MD; M. Camporesi MD PhDφ; R.
Salvia MD PhD#; F. Giovinazzo#* MD PhD; S. Zanini* PhD; G. Malleo# MD; A. Di
Tano MD PhD°; D. Mangar MD& and C. Bassi#* MD FACS FRCS .
€
Department of Biomedical Science – Laboratory of Phisiology, University of
Padova, Via Marzolo 3, IT
35131 Padova, Italy.ATIp, Hyperbaric Medical Center, Via Cornaro 1, Padova,
Italy.
#
Surgical Department, Istituto del Pancreas, Hospital ‘G.B. Rossi’, University of
Verona, Piazzale ‘LA. Scuro’, IT-37134 Verona, Italy.
$
φ
Hyperbaric Institute SpA Via Francia, 35, IT- 37069 Villafranca Verona, Italy.
Department of Surgery/Anesthesiology, University of South Florida, Tampa,
Florida, USA.
* Laboratory of Translational Surgery. University Laboratory for Medical
Research-Verona (L.U.R.M), University of Verona, Piazzale ‘L.A. Scuro’, IT37134 Verona, Italy.
° Department of basic and applied medical sciences, University of Chieti, Via
dei Vestini, 66100 Chieti, Italy.
&
FGTBA LLC Tampa , FL 33606, USA.
Abstract
In
abdominal
surgery,
pancreaticoduodenectomy
(PD)
represents
the
intervention mostly burdened by various local and systemic complications.
In this study we evaluated post-operative biological and clinical effects of a
single preoperative hyperbaric treatment the day before surgery for pancreatic
ductal adenocarcinoma.
The study was a prospective randomized single-blind study lasting 6 months in
21 patients (10 [group-A;47.6%], HBO-group and 11 [group-B;52.4%],
placebo-group).
Patients were randomized and divided into two groups: group-A was submitted
to a HBO session the day before PD intervention. Group-B patients breathed
air for 40 minutes in a hyperbaric chamber pressurized to 1.15 ATA.
In all patients blood samples were taken before HBO treatment or placeboprocedure (T0), at the end of HBO session or placebo-procedure (T1), on the
first post-operative day (POD) (T2) and on seventh POD (T3). We measured
interleukin (IL)-1,IL-6,IL-8,IL-10,IL-12p70 and TNF-α. Adverse outcomes that
were recorded included postoperative pancreatic fistula (POPF), biliary fistula,
fever, intra abdominal abscess, bleeding, pulmonary complications, delayed
gastric emptying and requirement for post-operative antibiotics.
Compared with Group B, patients in Group A had fewer postoperative
pulmonary infections (0/10 in group A vs 6/11 group B,
p=0.023). HBO-PC
modulates IL-6 synthesis (p=0.009) and IL-10 one (p=0.03), and does not
cause more bleeding compared to placebo (p = 0.450).
There was a statistically significant relationship between IL-6 and biliary fistula
(p=0.009).
IL-1
(p=0.006)
and
TNF-α
(p=0.04)
were
correlated
with
hyperpyrexia. TNF-α levels were related to POPF (p=0.019).
The results of this pilot study suggest that a single preoperative hyperbaric
oxygen treatment on the day before surgery may reduce the complication rate
in pancreatic resection.