PIPAC (Pressurized IntraPeritoneal Aerosol Chemotherapy) is a minimally invasive, laparoscopic technique that delivers chemotherapy as a pressurised aerosol inside the abdomen, for patients with peritoneal metastases. Unlike HIPEC — which is given as part of major cytoreductive surgery with curative intent when complete removal is feasible — PIPAC is repeatable and is usually for more advanced peritoneal disease not suitable for complete cytoreduction, mainly to control the disease and symptoms. The pressurised aerosol allows more uniform distribution and better penetration at lower doses. It is a specialised, emerging method; inclusion is decided by a multidisciplinary team, often within an individualised plan or clinical studies.
The management of peritoneal disease has been enriched in recent years with new, specialised approaches. One of these is PIPAC — a minimally invasive way of delivering chemotherapy that complements, rather than replaces, existing treatments.
What is PIPAC
PIPAC (Pressurized IntraPeritoneal Aerosol Chemotherapy) delivers chemotherapy drugs inside the abdomen, as a fine pressurised aerosol, during a laparoscopy. The pressure and the aerosol form help the drug distribute more uniformly and penetrate the tissues of the peritoneum better.
How it differs from HIPEC
- HIPEC: heated liquid chemotherapy, given as part of major cytoreductive surgery (CRS), with curative intent when complete removal of the visible disease is feasible.
- PIPAC: a chemotherapy aerosol under pressure, via laparoscopy, repeatable, usually for advanced peritoneal disease not suitable for complete cytoreduction — mainly to control the disease and symptoms.
The two methods do not compete; they cover different needs across the spectrum of peritoneal disease.
The advantages
- Uniform distribution and better penetration of the drug, thanks to the pressurised aerosol.
- Lower drug doses, with local action and fewer systemic side effects.
- Minimally invasive (laparoscopic), with a short hospital stay.
- Repeatable — it also allows reassessment of the disease with direct vision and biopsies at each session.
Which patients are candidates
It is for selected patients with peritoneal metastases — for example from stomach, colon, ovarian or appendiceal cancer — often when complete cytoreduction is not feasible. It can be combined with systemic chemotherapy (a bidirectional approach). Inclusion is always decided by a specialised multidisciplinary team (MDT).
How the procedure is done
Through a laparoscopy, a special nebuliser is introduced that sprays the chemotherapy as an aerosol into the abdominal cavity under pressure. The aerosol remains for a few minutes and is then safely removed. The procedure is short and, being minimally invasive, usually allows a short hospital stay and repetition at intervals.
What the evidence shows
PIPAC is an emerging method: the evidence so far is encouraging in terms of safety and control of the disease and symptoms, while clinical trials are ongoing that will define its role more precisely by tumour type. It is performed in specialised centres and often within organised protocols.
Recovery
As a minimally invasive procedure, PIPAC is usually accompanied by a short hospital stay and a gentle postoperative course, which also makes it repeatable. The exact planning is individualised. See the full page on peritoneal disease & HIPEC and the services.
What is PIPAC?
PIPAC (Pressurized IntraPeritoneal Aerosol Chemotherapy) is a minimally invasive, laparoscopic technique that delivers chemotherapy as a pressurised aerosol inside the abdominal cavity, to treat peritoneal metastases.
How does it differ from HIPEC?
HIPEC is heated liquid chemotherapy given as part of major cytoreductive surgery, with curative intent when complete removal of the disease is feasible. PIPAC is a repeatable, minimally invasive laparoscopic procedure using an aerosol, usually for advanced peritoneal disease not suitable for complete cytoreduction, often to control the disease.
Which patients are candidates?
Selected patients with peritoneal metastases (e.g. from stomach, colon, ovarian or appendiceal cancer), often when complete cytoreduction is not feasible. The decision is made by a specialised multidisciplinary team.
How often is it repeated?
PIPAC is designed as a repeatable treatment, typically every roughly 6 weeks for several sessions, often combined with systemic chemotherapy. The schedule is individualised.
Is it an established treatment?
It is a specialised, emerging technique performed in experienced centres; the evidence is evolving and it is often used within studies or as part of an individualised plan. It does not replace cytoreductive surgery with HIPEC when cure through complete removal is feasible.