PIPAC procedure – An alternative in the treatment of peritoneal cancer

View the full interview with Chief of Works Dr. Bartoș – a qualified medical doctor, focusing on the PIPAC (pressurized intraperitoneal chemotherapy) procedure for peritoneal cancer (peritoneal carcinomatosis). You can view the full interview by going to the youtube link or if you want to learn more about peritoneal carcinomatosis go to hipec.ro

What does PIPAC mean?

First of all, we need to emphasise what PIPAC therapy means.

PIPAC, is an acronym that stands for pressurized intraperitoneal chemotherapy, basically a special device gives us the ability to spray chemotherapy into the peritoneal cavity.

PIPAC therapy is different from the HIPEC procedure and is much better known worldwide, HIPEC being an intraperitoneal chemotherapy technology based on a fluid circulating in the intraperitoneal cavity. Of course, the two procedures are not different in chemotherapeutic principle, only in indication.

PIPAC, this pressurized intraperitoneal chemotherapy, is to help treat patients who are not amenable at the time of diagnosis to surgical resection, that cytoreductive surgery where we remove metastases and apply the HIPEC procedure.

Basically, it comes to prepare most of the time for major cytoreduction surgery and HIPEC, or in more unfortunate cases to provide an improvement in the lives of patients who can no longer benefit from systemic chemotherapy, basically patients who have exhausted their therapeutic resources, patients in very advanced stages who can no longer benefit from other treatments.

PIPAC is a rapidly developing procedure and there is a lot of research in the field of oncology, oncological treatments and in particular of this chemo-pressurised therapy.

So far, the procedure has not been standardized, the indications are still under discussion, at present the latest international consensus sets as a recommendation a minimum number of 3 such sessions, depending on the patient’s response.

We can be guided by the presence of malignant ascites, ascites due to peritoneal carcinomatosis. If it disappears after this chemotherapy treatment we can say that it is a therapeutic success, of course with palliative tint, but certainly then we can stop the procedure.

An advantage but also a limitation, at the same time, for this technique is that ideally it should be performed by the minimally invasive method, through those small punctures of the abdominal wall, with the trocars of laparoscopy, the patient benefiting from this chemotherapy session directly on the tumors, with a very fast recovery, practically needing one night of hospitalization, because this procedure requires general anesthesia.

Ideally, this technique, PIPAC, is performed, and can be performed, by minimally invasive surgery.

The PIPAC procedure addresses peritoneal cancers as well as the HIPEC technique, peritoneal metastases that are of colorectal, ovarian, gastric origin, retroperitoneal pseudomyxoma, when cytoreductive technique and HIPEC, hyperthermic intraperitoneal chemotherapy is not indicated or not possible.

Optimistically, we hope to convert patients from inoperability to operability through this procedure, which is the first element we are aiming for, and the second important element is that in patients with refractory ascites, ascites generated by these metastatic tumours, we try to improve the quality of life, with a purely palliative approach in those situations, through a direct action on the tumour formations, with the hope that ascites will no longer have that recurrent character, which affects the quality of life and organ functions.