Feasibility and Safety of Pressurized Intraperitoneal Aerosol Chemotherapy for Peritoneal Carcinomatosis: A Retrospective Cohort Study

Abstract

Background. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) has been introduced as a novel repeatable treatment for peritoneal carcinomatosis. The available evidence from the pioneer center suggests good tolerance and high response rates, but independent confirmation is needed. A single-center cohort was analyzed one year after implementation for feasibility and safety. Methods. PIPAC was started in January 2015, and every patient was entered into a prospective database. This retrospective analysis included all consecutive patients operated until April 2016 with emphasis on surgical feasibility and early postoperative outcomes. Results. Forty-two patients (M : F = 8 : 34, median age 66 (59-73) years) with 91 PIPAC procedures in total (4×: 1, 3×: 17, 2×: 12, and 1×: 12) were analyzed. Abdominal accessibility rate was 95% (42/44); laparoscopic access was not feasible in 2 patients with previous HIPEC. Median initial peritoneal carcinomatosis index (PCI) was 10 (IQR 5-17). Median operation time was 94 min (89-108) with no learning curve observed. One PIPAC application was postponed due to intraoperative intestinal lesion. Overall morbidity was 9% with 7 minor complications (Clavien I-II) and one PIPAC-unrelated postoperative mortality. Median postoperative hospital stay was 3 days (2-3). Conclusion. Repetitive PIPAC is feasible in most patients with refractory carcinomatosis of various origins. Intraoperative complications and postoperative morbidity rates were low. This encourages prospective studies assessing oncological efficacy.

Figure 1

Pressurized intraperitoneal aerosol chemotherapy (PIPAC). The abdominal cavity is accessed with 2 balloon trocars allowing hermetic seal. Liquid chemotherapy is dispersed as aerosol by use of a standard injector and a specific nebulizer. Reprinted from Rev Med Suisse [21] with permission from Médicine et Hygiène.

Figure 2

Flow of patients treated with pressurized intraperitoneal aerosol chemotherapy (PIPAC).

Figure 3

Correlation of tumor load with operation time and hospital stay. The extent of peritoneal disease (measured by the peritoneal cancer index: PCI) was plotted against operation time (a) and length of hospital stay (LOS) (b).