What is Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) procedure?

From the Guidelines

PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy) is a novel method of intraperitoneal chemotherapy administration, where aerosolized chemotherapy is directly administered to the peritoneum through a laparoscope, as described in the study published in the Journal of Clinical Oncology in 2022 1. The procedure involves the administration of chemotherapy drugs, such as cisplatin, doxorubicin, or oxaliplatin, in an aerosolized form, which allows for better distribution and penetration of the drugs throughout the peritoneal surfaces. Some key points about the PIPAC procedure include:

• It is a minimally invasive procedure used to treat certain cancers that have spread to the peritoneal cavity
• The procedure typically takes 90-120 minutes and is performed under general anesthesia
• Two small incisions are made in the abdomen: one for a camera to visualize the peritoneal cavity and another for the nebulizer device that delivers the aerosolized chemotherapy
• PIPAC is usually administered in repeated sessions every 4-6 weeks, with most patients receiving 3-6 treatments depending on their response
• The main advantage of PIPAC is that it delivers high concentrations of chemotherapy directly to cancer cells while minimizing systemic side effects, as noted in the study published in the Journal of Clinical Oncology in 2022 1. The role of PIPAC in the treatment of gastric cancer peritoneal metastasis requires further evaluation and should only be performed within the framework of clinical trials, as stated in the study published in the Journal of Clinical Oncology in 2022 1.

From the Research

Overview of PIPAC Procedure

• The Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) procedure is a novel approach for treating peritoneal carcinomatosis, a common evolution of abdominal cancers with poor prognosis 2.
• PIPAC involves the administration of chemotherapy agents as a pressurized aerosol into the peritoneal cavity, which has been shown to enhance the effect of chemotherapy without reported renal or hepatic toxicity 2, 3.

Technical Aspects of PIPAC

• The procedure is typically performed under general anesthesia and capnoperitoneum, using two balloon trocars placed in the midline 2.
• A nebulizer is inserted and connected to a high-pressure injector, and a pressurized aerosol containing chemotherapy agents is administered into the peritoneal cavity 2.
• The aerosol is kept in a steady-state for 30 minutes before being exhausted through a closed filter system 2.

Efficacy and Safety of PIPAC

• Studies have shown that PIPAC is a safe and feasible treatment option for patients with peritoneal carcinomatosis, with acceptable toxicity and promising survival benefits 4, 5, 6.
• PIPAC has been shown to induce regression of peritoneal carcinomatosis in chemoresistant tumors, using a lower dose of chemotherapy than traditional systemic chemotherapy 3.
• The procedure has been associated with low postoperative morbidity and short hospital stays, with no negative impact on quality of life reported 6.

Indications and Patient Selection

• PIPAC may be a useful treatment option for selected patients with peritoneal carcinomatosis, including those with colorectal, gastric, and gynecological cancers 4.
• Patient selection criteria and standardized reporting of PIPAC procedures are necessary to ensure the safe and effective use of this treatment approach 4.