PIPAC

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Peritoneal dissemination is a prevalent pathway for cancer metastasis, and administering chemotherapy directly into the peritoneal cavity offers significant advantages. Intraperitoneal (IP) chemotherapy achieves much higher drug concentrations in the abdominal cavity compared to intravenous (IV) methods. Clinical studies indicate a survival benefit for IP chemotherapy across various tumor types, including ovarian, gastric, and colorectal cancers. Despite its growing acceptance, IP chemotherapy faces challenges due to increased toxicity and limited efficacy stemming from poor drug distribution and tissue penetration. A novel approach, pressurized intraperitoneal aerosol chemotherapy (PIPAC), utilizes a pressurized aerosol of cytotoxics delivered laparoscopically. This method establishes a normothermic capnoperitoneum at 12 mmHg, where a cytotoxic solution is nebulized into the abdominal cavity for 30 minutes before being suctioned out. This aerosol application ensures uniform distribution of the drug and creates an artificial pressure gradient that enhances drug penetration while maintaining low plasma concentrations. Initial clinical studies in ovarian, gastric, colorectal cancers, and peritoneal mesothelioma show promising tumor response rates and minimal side effects. Ongoing larger trials aim to validate these findings and explore broader applications.