PIPAC: A New Hope for Abdominal Cancer When Chemotherapy Fails

HIPEC (Hyperthermic Intraperitoneal Chemotherapy) is relatively well-known now. This surgery entails removal of all abdominal tumour (Complete cytoreductive surgery) followed by the circulation of heated chemotherapy within the abdominal cavity to directly kill microscopic tumour cells. This treatment option is usually curative, which means complete tumour eradication may be possible. But this is often not feasible.

For tumours like ovarian cancer, stomach cancer, colon cancer, appendicular cancer as well as some other abdominal tumours, which have spread substantially within the abdominal cavity, generally chemotherapy is advised. Chemotherapy may also be given if the tumour recurs after surgery or other initial treatment.

Is there an option if multiple lines of systemic chemotherapy are exhausted? Yes, there is. One such option is a novel treatment called PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy). Firstly, this is a palliative treatment option and cure is unlikely. Secondly, no tumour is surgically removed. It is new chemo-delivery system in which chemotherapy is instilled directly into the abdominal cavity in a spray form via a laparoscope. This procedure requires general anaesthesia and a special operation theatre set-up with trained clinicians. Also, the patient’s general condition should be fit enough to undergo this procedure.

Finally, PIPAC is offered only in select centers such as ours which select appropriate patients for best outcomes. There is substantial evidence already and more data is emerging, reporting superior survival and quality of life when PIPAC is used.

Multiple sessions are usually required, but it is a safe and effective procedure when performed selectively and effectively. Cost prohibitions do exist because of the extensive number of disposable products used during this procedure.

Overall, PIPAC is an encouraging new treatment option offering better outcomes for selected patients with abdominal cancer and is worth considering especially when other options have been exhausted.