PIPAC for Peritoneal Carcinomatosis – moving on to IDEAL Stage 2b

12th April 2021

This month we are highlighting an oncology problem which has been very difficult to treat – peritoneal carcinomatosis.

While progress has been made applying cytoreductive surgery and intraperitoneal chemotherapy (HIPEC) for ovarian cancer, the common GI cancers have been resistant to the agents used.

Ceelan recently published an article in the British Journal of Surgery ( 2021 ) titled Peritoneal carcinomatosis: is it all up in the air?

This new method of introducing chemotherapy involves nebulizing the drugs during laparoscopy. This can even be done in the neoadjuvant setting.

This new method uses the acronym PIPAC – pressurized intraperitoneal aerosol chemotherapy. This has been used with promising results in gastric cancer. Citation; Alyami, M et al: Pressurized intraperitoneal aerosolized chemotherapy ( PIPAC ) for unresectable peritoneal metastasis from gastric cancer. Eur J Surg Oncol 2021;47: 123-127. They showed a significant improvement in survival in 42 patients compared to historical controls.

As Ceelan pointed out, the PIPAC method has progressed from the proof of concept stage to the IDEAL 2a stage (development). As of now, we can say that the technique appears to be safe and that it has some effectiveness in metastatic gastric cancer. More centers are beginning to use this method.

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