Surgical procedure
tumor
TUMOR, CAVITY, POSTOPERATIVE COMPLICATIONS
As described by our group (Gockel et al. Peritoneal biopsies (flank, upper and lower abdomen, right and left side) were taken, where accessible, in a standardized manner according to our protocol. They were sent for pathological analysis. All samples were fixed in 4% buffered formalin, embedded in paraffin, cut in 4 µm thick layers, and stained with hematoxylin and eosin (H&E) using an automated slide stainer (Sakura Tissue Tek Prisma, Tokyo, Japan). The relative area covered by tumor cells (in %) was determined by two experienced pathologists (KS and HB). The biopsy containing the most tumor cells was considered when assessing tumor changes between PIPAC procedures.The micropump (Capnomed GmbH, Villingendorf, Germany) was inserted into the 12 mm trocar to perform the PIPAC procedure. Following our checklist, the injection pump (Medrad Arterion Mark 7, Leverkusen, Germany) was carefully connected, and all personnel left the operating room. The chemotherapy application was controlled with a footswitch and could be monitored through a window in the closed-off preparation room. The anesthesia was supervised by the responsible staff in the same way. They had the option to apply medication through two syringe pumps connected to the patient by long tubes. Chemotherapy was applied through the injection pump at a maximum pressure of 200 psi and a flow rate of 0.5 mL/min. Subsequently, the micropump vaporized the drugs inside the abdominal cavity. First, 7.5 mg/mAfter having been monitored for a few hours in the post-anesthesia care unit, patients were transferred to our ward, where any postoperative complications were documented prospectively according to the CDC (Dindo et al. 