Feasibility and safety of PIPAC combined with additional surgical procedures: PLUS study

PIPAC for Gastrointestinal Malignancies

“…Absolute contraindications include bowel or urinary obstruction without the ability to safely and easily bypass or divert; inability to access the abdomen safely; significant abdominal adhesions; recent bowel perforation or intra-abdominal sepsis; inability to tolerate laparoscopy from a cardiopulmonary perspective; or other medical conditions that would preclude surgery, such as poor performance status [22]. While cytoreduction is generally not performed with PIPAC, one study added other surgical procedures, such as adhesiolysis, omentectomy, hernia repair, and gastrectomy, to the treatment and found no increase in surgical complications compared to PIPAC alone, although LOS, surgery time, and medical complications, such as pain, nausea, and ileus, were increased [24]. Failure to access the abdomen can be secondary to adhesions from prior procedures or from tumor involving the abdominal wall and preventing safe entry and/or expansion.…”

“…Major complications during or after PIPAC have been reported, with rates of 0 to over 62%; however, as with all procedures, this decreases with improved patient selection and experience [22,24,33,40]. Examples of complications reported after PIPAC include superficial infection, fascial dehiscence, bowel injury during access, intestinal obstruction, aspiration, and pleural effusion [22,40,42,50].…”