Pressurised intraperitoneal aerosolised chemotherapy (PIPAC) for peritoneal malignancy, a systematic review of its occupational safety

Abstract

Pressurised intraperitoneal aerosolised chemotherapy (PIPAC) is an emerging technique for treating peritoneal malignancies, in which chemotherapeutic agents are delivered as an aerosol during laparoscopy. This method may provide more uniform distribution and deeper tissue penetration compared to hyperthermic intraperitoneal chemotherapy (HIPEC). However, the aerosolization of cytotoxic agents raises potential occupational health concerns for surgical and perioperative staff. This systematic review aimed to evaluate the occupational safety of the PIPAC procedure. A comprehensive search of PubMed, EMBASE, and Web of Science identified 854 studies, of which 9 met the inclusion criteria. These prospective studies, conducted across European centres between 2013 and 2021, collectively assessed 24 PIPAC procedures. Exposure was evaluated through environmental air sampling, surface wipe analysis, and biological monitoring (urine or plasma samples). Across the included studies, air contamination was consistently undetectable or below established safety thresholds. Biological monitoring also revealed no measurable systemic exposure in healthcare workers. While some surface contamination was identified, primarily on gloves and equipment, detected levels were below those commonly reported in HIPEC procedures. These findings suggest that, when appropriate safety measures are in place, PIPAC poses minimal occupational risk to healthcare staff.