PIPAC is a minimally invasive technique that delivers chemotherapy as a pressurized aerosol into the peritoneal cavity, via laparoscopy. It is for selected patients with peritoneal carcinomatosis, can be repeated in cycles and is often combined with systemic chemotherapy.
What is PIPAC?
PIPAC is a minimally invasive technique that delivers chemotherapy as a pressurized aerosol into the peritoneal cavity, via laparoscopy. The aerosol form achieves more even distribution and better penetration of the peritoneum, with low doses and limited systemic toxicity.
Unlike HIPEC, it is not combined with extensive cytoreduction and can be repeated in cycles.
When is it needed?
It is for selected patients with peritoneal carcinomatosis who are not candidates for cytoreduction/HIPEC, for disease and symptom control (e.g. ascites), or as part of a conversion strategy. It applies to spread from gastric, colorectal, ovarian and other tumours.
Preparation
It is preceded by staging, often a diagnostic laparoscopy with assessment of extent (PCI) and biopsies, and a decision by a multidisciplinary team at a specialist centre.
How it's done
Through laparoscopy the abdomen is insufflated and a special nebuliser sprays the chemotherapy as a pressurized aerosol, which distributes evenly over the peritoneal surface for a set time. The procedure is short and strict safety measures for aerosolized chemotherapy are followed.
Pressurized aerosol
Even distribution and better drug penetration of the peritoneum, with low doses.
Repeatable
Delivered in cycles (typically every ~6 weeks), often combined with systemic chemotherapy.
Multidisciplinary team
Patient selection and planning are done at a specialist centre.
Recovery
Because of its minimally invasive nature and low systemic toxicity, the hospital stay is usually short. Cycles are typically repeated every ~6 weeks, with close monitoring and in coordination with the multidisciplinary team.
Risks & outcomes
Generally well tolerated, with low systemic toxicity. Risks relate mainly to the laparoscopy and a specialist safety setup is required. In selected patients it offers meaningful disease control.
Frequently asked questions
How does PIPAC differ from HIPEC?
HIPEC is delivered as a heated liquid during cytoreductive surgery, in an open operation. PIPAC is minimally invasive (laparoscopic), delivers the drug as a pressurized aerosol and can be repeated in cycles — often in patients who are not candidates for cytoreduction/HIPEC.
Is it curative?
In most cases it has a palliative or conversion role: it controls disease and symptoms such as ascites and, in selected patients, may contribute to a later surgical strategy.
Is it repeatable?
Yes. PIPAC is planned in cycles, typically every ~6 weeks, and is often combined with systemic chemotherapy.
Which tumours is it for?
Mainly for peritoneal spread from gastric, colorectal, ovarian and other peritoneal malignancies, in selected patients.