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For patients with metastatic tumors, peritonectomy and cytoreductive surgery are performed to reduce the spread of disease. Patient selection for this treatment involves specific criteria. For instance, in a patient with colon cancer, even if the tumor spread has not reached the liver, diffuse peritoneal dissemination may occur. In such cases, the peritoneal membrane is completely stripped and removed. The surgeon eradicates all accessible tumors surgically or by cauterization. Following this debulking, heated chemotherapeutic agents (up to 43°C) are directly administered into the abdominal cavity via drains, a procedure known as Hyperthermic Intraperitoneal Chemotherapy (HIPEC). This combined approach is termed cytoreductive surgery with HIPEC. When this extensive intervention is not feasible, Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) offers an alternative.
In the PIPAC method, chemotherapeutic drugs are administered into the abdominal cavity, similar to standard chemotherapy, but at significantly reduced doses, typically about 1/10th of systemic doses. For instance, if 10 grams of medication are given intravenously for systemic chemotherapy to control peritoneal metastases, a similar efficacy can be achieved with only 1 gram in PIPAC. This approach minimizes the cytotoxic effects of anti-cancer drugs on healthy cells while maintaining high efficacy.
This laparoscopic treatment involves entering the abdominal cavity through two small incisions, typically 1 cm and 0.5 cm. The choice of drug depends on the primary tumor's origin. High-pressure chemotherapeutic drugs are delivered via trocars using a pen-like device (Kapnopen) to aerosolize and uniformly distribute the medication throughout the abdominal cavity. This unique delivery method enhances patient benefit. During the procedure, reference markers are placed, allowing for repeat treatments after approximately six weeks if needed. This treatment can be repeated every six weeks for up to 7-8, or even 10 sessions. Significant tumor regression, often near complete disappearance at the marked sites, has been observed by the third or fourth treatment session.
Follow-up studies have indicated significant patient benefit from this treatment. If the patient responds positively, the application can be repeated after six weeks, providing a significant advantage due to its re-applicability. This offers hope to patients for whom other treatment options are limited. The PIPAC method has been shown to extend patient survival. In some cases, a life expectancy of one to two months can be extended tenfold. However, patient selection is crucial, considering general health, cellular structure, tumor type, and genetic profile.
How is PIPAC performed/applied?
In the PIPAC method, chemotherapeutic drugs are administered into the abdominal cavity, similar to standard chemotherapy, but at significantly reduced doses, typically about 1/10th of systemic doses. For instance, if 10 grams of medication are given intravenously for systemic chemotherapy to control peritoneal metastases, a similar efficacy can be achieved with only 1 gram in PIPAC. This approach minimizes the cytotoxic effects of anti-cancer drugs on healthy cells while maintaining high efficacy.
This laparoscopic treatment involves entering the abdominal cavity through two small incisions, typically 1 cm and 0.5 cm. The choice of drug depends on the primary tumor's origin. High-pressure chemotherapeutic drugs are delivered via trocars using a pen-like device (Kapnopen) to aerosolize and uniformly distribute the medication throughout the abdominal cavity. This unique delivery method enhances patient benefit. During the procedure, reference markers are placed, allowing for repeat treatments after approximately six weeks if needed. This treatment can be repeated every six weeks for up to 7-8, or even 10 sessions. Significant tumor regression, often near complete disappearance at the marked sites, has been observed by the third or fourth treatment session.
Follow-up studies have indicated significant patient benefit from this treatment. If the patient responds positively, the application can be repeated after six weeks, providing a significant advantage due to its re-applicability. This offers hope to patients for whom other treatment options are limited. The PIPAC method has been shown to extend patient survival. In some cases, a life expectancy of one to two months can be extended tenfold. However, patient selection is crucial, considering general health, cellular structure, tumor type, and genetic profile.