Technical considerations for isolated limb perfusion: A consensus paper

Hayes AJ, Coker DJ, Been L, Boecxstaens VW, Bonvalot S, De Cian F, de la Cruz-Merino L, Duarte C, Eggermont A, Farricha V, Fiore M, Grünhagen D, Grützmann R, Honoré C, Jakob J, Hocevar M, van Houdt W, Klauzner J, Kettelhack C, Märten A, Martinez-Said H, Matter M, Michot A, Niethard M, Pennacchioli E, Podleska LE, Rabago G, Rastrelli M, Reijers S, Ribeiro M, Schwarzbach M, Snow HA, Spacek M, Stoldt S, Testori A, Zoras O, Olofsson Bagge R (2024)

Publication Type: Journal article, Review article

Publication year: 2024


Book Volume: 50

Article Number: 108050

Journal Issue: 6

DOI: 10.1016/j.ejso.2024.108050


Background: Isolated limb perfusion (ILP) is a well-established surgical procedure for the administration of high dose chemotherapy to a limb for the treatment of advanced extremity malignancy. Although the technique of ILP was first described over 60 years ago, ILP is utilised in relatively few specialist centres, co-located with tertiary or quaternary cancer centres. The combination of high dose cytotoxic chemotherapy and the cytokine tumour necrosis factor alpha (TNFα), mandates leakage monitoring to prevent potentially serious systemic toxicity. Since the procedure is performed at relatively few specialist centres, an ILP working group was formed with the aim of producing technical consensus guidelines for the procedure to streamline practice and to provide guidance for new centres commencing the technique. Methods: Between October 2021 and October 2023 a series of face to face online and hybrid meetings were held in which a modified Delphi process was used to develop a unified consensus document. After each meeting the document was modified and recirculated and then rediscussed at subsequent meeting until a greater than 90% consensus was achieved in all recommendations. Results: The completed consensus document comprised 23 topics in which greater than 90% consensus was achieved, with 83% of recommendations having 100% consensus across all members of the working group. The consensus recommendations covered all areas of the surgical procedure including pre-operative assessment, drug dosing and administration, perfusion parameters, hyperthermia, leakage monitoring and theatre logistics, practical surgical strategies and also post-operative care, response evaluation and staff training. Conclusion: We present the first joint expert-based consensus statement with respect to the technical aspects of ILP that can serve as a reference point for both existing and new centres in providing ILP.

Authors with CRIS profile

Involved external institutions

Universitätsklinikum Essen DE Germany (DE) University of Crete / Πανεπιστήμιο Κρήτης GR Greece (GR) Sahlgrenska University Hospital / Sahlgrenska Universitetssjukhuset SE Sweden (SE) University of Padua / Universita degli Studi di Padova IT Italy (IT) Antoni van Leeuwenhoek NL Netherlands (NL) Oslo University Hospital / Oslo Universitetssykehus Rikshospitalet NO Norway (NO) European Organisation for Research and Treatment of Cancer (EORTC) BE Belgium (BE) Instituto Português de Oncologia do Porto FG, EPE (IPO-Porto) PT Portugal (PT) Universitätsklinikum Frankfurt am Main (KGU) DE Germany (DE) Peter MacCallum Cancer Centre AU Australia (AU) University Hospital Leuven (UZ) / Universitaire ziekenhuizen Leuven BE Belgium (BE) Institut Gustave-Roussy FR France (FR) Universitätsklinikum Mannheim DE Germany (DE) Institute for Oncology Ljubljana (OIL) SI Slovenia (SI) Institut Curie FR France (FR) Hospitales Universitarios Virgen Macarena y Virgen del Rocío ES Spain (ES) Clínica Universidad de Navarra ES Spain (ES) University Medical Centre Utrecht (UMC Utrecht) NL Netherlands (NL) Instituto Português de Oncologia Francisco Gentil (IPO) / Portuguese Oncology Institute PT Portugal (PT) Fondazione IRCCS: Istituto Nazionale dei Tumori IT Italy (IT) Erasmus University Medical Center (MC) NL Netherlands (NL) Tel Aviv University IL Israel (IL) Clarunis Universitäres Bauchzentrum Basel CH Switzerland (CH) BELPHARMA s.a. LU Luxembourg (LU) Instituto Nacional de Cancerología MX Mexico (MX) Institut Bergonié FR France (FR) Lausanne University Hospital / Centre hospitalier universitaire vaudois (CHUV) CH Switzerland (CH) HELIOS Kliniken DE Germany (DE) European Institute of Oncology / Istituto Europeo di Oncologia (IEO) IT Italy (IT) Royal Marsden Hospital / The Royal Marsden NHS Foundation Trust GB United Kingdom (GB) Ospedale Policlinico San Martino IT Italy (IT) University Medical Center Groningen (UMCG) / Universitair Medisch Centrum Groningen NL Netherlands (NL) General University Hospital in Prague / Všeobecná Fakultní Nemocnice v Praze (VFN) CZ Czech Republic (CZ)

How to cite


Hayes, A.J., Coker, D.J., Been, L., Boecxstaens, V.W., Bonvalot, S., De Cian, F.,... Olofsson Bagge, R. (2024). Technical considerations for isolated limb perfusion: A consensus paper. Ejso, 50(6).


Hayes, Andrew J., et al. "Technical considerations for isolated limb perfusion: A consensus paper." Ejso 50.6 (2024).

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