PIPAC – Pressurized Intraperitoneal Aerosol Chemotherapy
PIPAC is a new treatment option for peritoneal carcinomatosis. PIPAC as an alternative to HIPEC (Hyperthermic Intraperitoneal Chemotherapy) for patients with peritoneal lesions on the background of various oncological diseases. In this minimally invasive procedure, the peritoneal cavity is treated with a pressurized chemotherapy solution.
How PIPAC works
PIPAC is performed in the operating room under general anesthesia through a small incision in the anterior abdominal wall. A low dose of a cytotoxic solution is used to treat the abdomen. This is only 10-20% of the standard treatment dose.
The solution is sprayed using a micropump, which converts the liquid into an aerosol and distributes it evenly throughout the peritoneum. After 30 minutes, the solution is removed by suction. The procedure is performed with high pressure in the abdominal cavity, which allows the drugs to penetrate the tissues actively.
The choice of drugs depends on the type of cancer. In some cases, it is possible to use several drugs simultaneously or in combination with systemic therapy.
Advantages of the procedure
- Uniform distribution of the drug throughout the abdominal cavity
- Deep penetration into the peritoneum
- Low toxicity of treatment due to low drug dose
- PIPAC with platinum is also effective for platinum-resistant cancers
- This technique can be successfully combined with systemic chemotherapy
Side effects are practically absent, since the drugs do not enter the systemic bloodstream. Absorption of cytotoxic drugs is prevented by the hemoperitoneal barrier.
Treatment of HIPEC and PIPAC for peritoneal cancer
Patients often compare PIPAC with surgery and HIPEC. It is clear that each method has its own advantages and disadvantages.
HIPEC has been used for decades to treat peritoneal carcinomatosis, stage 4 of cancer. Therefore, this technology is being better studied. Doctors know exactly when, who and how to best perform this procedure.
PIPAC is a relatively new treatment, but compared to HIPEC it is safer, less invasive, much better tolerated and does not require long-term rehabilitation. It does not require a wide incision across the entire anterior abdominal wall.
While HIPEC is used only after cytoreductive surgery, PIPAC can be performed as a stand-alone procedure even in patients where surgery is not possible, such as those with small intestine involvement or end-stage peritoneal carcinomatosis.
Another advantage of PIPAC therapy is that it can be repeated multiple times. In contrast, HIPEC is performed only once.
After multiple PIPAC procedures for inoperable peritoneal carcinomatosis, the cancer may regress and become operable. This is not possible with HIPEC, because treatment can only start with surgery to remove the tumor and patients cannot receive intraperitoneal hyperthermic chemotherapy if they are deemed inoperable.
