Pressurized Intra-Peritoneal Aerosol Chemotherapy (PIPAC) is a novel treatment modality for patients with refractory peritoneal cancers. It is novel technique delivering chemotherapeutic drug in aerosolized form into the abdominal cavity through laparoscopic approach using a special nebulizer device.
It has the benefits of:
- Intraperitoneal administration (increased intra-tumoural concentrations, low systemic toxicity)
- Pressurizedvaporization (homogenous distribution, deep penetration)
- Minimallyinvasiveapproach (repetitive application possible, lowmorbidity, better quality of life)
Most abdominal cancers (Gastric, Colorectal, Ovarian and Appendicular cancers) in advanced stages have diffuse spread to Peritoneum. Currently these patients are treated with systemic therapy - chemotherapy or targeted monoclonal antibodies; however,these drugs may not reach the peritoneum in adequate concentrations to be effective.
PIPAC involves a laparoscopic approach wherein two trocars or hollow tubes are placed into the belly and carbon dioxide gas is used to create a working space. Following this a systematic survey of the abdomen is carried out with a camera and the extent of the cancer in the peritoneum and on the intestines is carried out followed by biopsies from 4 regions. Subsequently the chemotherapy drug is pushed under pressure into the abdomen, leading to formation of a vapour which penetrates deep into the cancerous tissue and eventually destroys them. It has the advantage of attaining high concentrations of drug in peritoneum and subsequently better clinical results. Due to laparoscopic approach, the procedure can be repeated multiple times and response can be assessed every time.
This procedure has been pioneered in Germany and is being practiced in multiple European and Asian Centers. Clinical results reported from these centers is encouraging.
- It reduces the incidence of bowel obstructions and ascites [Fluid collection in the abdomen].
- It improves survival significantly.
Trained and certified after attending PIPAC work shop and certification program at the National University of Singapore in November 2019.