Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) in patients with peritoneal metastasized colorectal, appendiceal and small bowel cancer

Abstract

Background: Patients with intestinal cancer (colorectal, appendiceal, and small bowel) with peritoneal metastases (PM) have a poor prognosis. We assessed whether pressurized intraperitoneal aerosol chemotherapy (PIPAC) together with systemic chemotherapy is an effective treatment option for these entities in palliative intent. Methods: Between November 2015 and February 2018, prospective data registry was performed (NCT03100708). Thirteen patients with intestinal cancer (median age 61 years [range 49–77]) underwent 26 PIPAC procedures with a median number of 2 interventions per patient (range 1–6). A chemoaerosol consisting of cisplatin/doxorubicin was administered during standard laparoscopy. Results: The median peritoneal carcinomatosis index according to Sugarbaker before the first PIPAC was 14 (range 2–27), and the median ascites volume was 10 mL (range 0–6300 mL). Six patients who received 2 or more PIPAC procedures had decreased and stable ascites volumes, while only 1 patient displayed increased ascites. The median overall survival was 303 days (range 30–490) after the first PIPAC procedure. Conclusions: PIPAC offers a novel treatment option for patients with PM. Our data show that PIPAC is safe and well-tolerated. Ascites production can be controlled by PIPAC in patients with intestinal cancer. Further studies are required to document the significance of PIPAC within palliative therapy concepts. Trial registration: NCT03100708

Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC)-directed treatment of peritoneal metastasis in end-stage colo-rectal cancer patients

“…Another aspect, with alleged relevance for the palliative management of these advanced CRC patients, was reflected by our observation that PIPAC substantially reduced ascites formation. Similar observations have been made when using PIPAC-directed therapy in PM for other diseases [20]. When we followed all our 24 patients, we recorded a median survival of 37.6 (range 10.2-47.0) months from the time of PM diagnosis, whereas it was 20.5 (range 0.13-34.7) months following the start of the first PIPAC session.…”

Pressurized intraperitoneal aerosol chemotherapy (PIPAC) for peritoneal malignancy: initial experience of the first program in the Baltic countries

“…A second most common indication for PIPAC is a refractory accumulation of ascites, which impairs quality of life [ 16 ]. It has been reported that PIPAC is an excellent method to control ascites, thus it improves the quality of life at the final stages of the disease [ 17 ].…”

Pressurized intraperitoneal aerosol chemotherapy (PIPAC) in patients with peritoneal surface malignancies (PSM): a prospective single-center registry study

“…As described by our group (Gockel et al 2018(Gockel et al , 2020 and others (Hübner et al 2017;Nowacki et al 2018), the PIPAC procedure was performed laparoscopically and under general anesthesia, strictly following our internal standard operating procedures (SOP). First, 12 mmHg capnoperitoneum was induced via a mini-laparotomy measuring 1-2 cm.…”