Hyperthermic interperitoneal chemotherapy (HIPEC) / Pressurized intraperitoneal aerosol chemotherapy (PIPAC)

Cytoreductive Surgery (CRS) with Subsequent Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

For certain tumors causing peritoneal carcinomatosis and primary peritoneal malignancies, there are surgical options that extend beyond palliative care. Examples include peritoneal carcinomatosis associated with colorectal and ovarian cancers. A key prerequisite for this therapeutic approach is the potential to achieve optimal cytoreduction. This requires that tumor nodules in the peritoneum are localized effectively. If there is no widespread involvement of the small intestine, complete resection—or complete cytoreduction—of the nodules is often achievable. This frequently includes necessary resections of organs, such as parts of the colon, gynecological organs, and the gallbladder, among others.

Once optimal cytoreduction is confirmed intraoperatively, heated chemotherapy is introduced into the abdominal cavity using a specialized machine and drainage tubes. This chemotherapy fluid remains in place for 90 minutes before being drained. The patient is then transferred to the intensive care unit (ICU) for close monitoring. This type of surgery can last eight to ten hours, followed by several days of intensive care. The usual hospital stay is 10 to 14 days. Cytoreductive surgery with HIPEC is typically intended as a curative treatment but may also serve as palliative debulking to reduce tumor mass. Prior to CRS and HIPEC, ongoing systemic chemotherapy is paused for four to six weeks.

Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC)

In contrast to the usually curative intent of CRS and HIPEC, Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) is a palliative treatment. It is used in combination with systemic chemotherapy for patients with non-resectable peritoneal carcinomatosis or in cases where resection would not improve survival. PIPAC may help reduce ascites and, ideally, lessen peritoneal carcinomatosis. PIPAC is performed laparoscopically, requiring only minimally invasive access to the abdominal cavity. If access is possible, PIPAC is generally well tolerated, does not require postoperative ICU care, and involves an inpatient stay of about three days. Potential side effects include nausea, vomiting, and fever.

PIPAC therapy is typically administered three times at intervals of six to eight weeks. Systemic chemotherapy is paused two weeks before and resumed two weeks after each PIPAC procedure.