Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC): ChemoAblation for Peritoneal Tumors

Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) is a novel way to deliver chemotherapy for peritoneal metastases originating from various gastrointestinal and gynecological primary tumors. Originally introduced by Dr. Reymond in 2011, PIPAC entails regional drug delivery into the peritoneal cavity and distributes chemotherapy to peritoneal metastasis as a pressurized aerosol. Compared to other regional therapies, aerosolized drug delivery under pressure allows for homogenous drug distribution. As PIPAC is performed as a minimally invasive procedure with laparoscopy, it can be repeated multiple times and is well tolerated by patients with a good safety profile. The first clinical applications of PIPAC were palliation of symptoms for heavily pretreated patients with end-stage disease with safety and reduction of ascites being the primary outcomes of early studies. However, more recent studies have reported preliminary clinical efficacy in support of prospective randomized trials. Additionally, the role of PIPAC as a conversion therapy is being explored in patients with borderline resectable carcinomatosis. With PIPAC’s growing popularity, there is a need for comparative clinical trials to assess its efficacy in comparison to standard of care regimens.