PIPAC Therapy

PIPAC Therapy for advanced colorectal cancer


The majority of the patients who are diagnosed with colorectal cancer with metastases have their metastases in the liver or in the peritoneum. Most of these cases cannot be cured by surgery alone. This is especially true if there are extensive peritoneal metastases. 

Most often patients are treated with chemotherapy through the veins that are comparatively ineffective against peritoneal metastases. Alternative treatments like, surgical removal of affected tissue ( debulking and cytoreductive surgeries) alone or combined with perioperative therapy also provides a restricted result and might be difficult in very extensive peritoneal spread and adhesions. 

PIPAC Therapy

This is where experts’ developed a new technique called Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) which plays an important role. Though this technique was developed for palliative settings with extensive peritoneal spread but has been seen to help in reducing the bulk of cancer very much and making definitive debulking surgeries possible improving the survival even in extensive cancer spread.

PIPAC: An effective countermeasure

PIPAC is being used in patients with colorectal, ovarian, gastric and appendiceal cancers and other rare peritoneal tumours in the palliative setting. It is offered to patients who have progressive peritoneal disease on one or more lines of systemic chemotherapy, patients who do not want systemic chemotherapy and those who have chemotherapy-refractory ascites due to any primary tumour. It can also be applied to other rare peritoneal tumours where cytoreductive surgery and HIPEC is not feasible.

Application of the method

PIPAC can only be applied by short laparoscopic procedure, during which chemotherapy is dispersed as a pressurized aerosol into the peritoneal cavity for 30 minutes, directly against the peritoneal metastases. This makes the method equally effective against peritoneal metastases than chemotherapy through the veins. This is a minimally invasive procedure and has shown good response rates in patients who are progressive on chemotherapy with minimal side effects. It can currently be used for the patients to limit the intensity of the disease and/or symptoms and thus enhance the quality of life.

Advantages

  • Increased tumour drug penetration using 1/10 of systemic doses
  • Easy to execute no learning curve
  • Limited major morbidity
  • Possibility of multiple applications
  • Can be combined with systemic chemotherapy
  • Response to therapy can be evaluated
  • Limited risk of port-site metastases
  • Minimal adhesion formation
  • Subsequent CRS and HIPEC is possible

Possible complications

  • Pain
  • Nausea
  • Fever
  • Wound infection
  • Trocar site hernias
  • Bowel access lesions
  • Subcutaneous toxic emphysema
  • Small bowel obstruction
  • Port site metastasis
  • Therapy resistant ascites

The side-effects of PIPAC are mostly very mild and the risks of side-effects are considered to be lower than the risk of side-effects of chemotherapy through the veins.

Authored by Dr. Shabnam Bashir

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About Dr. Shabnam Bashir

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Dr. Shabnam Bashir has time and again proved her extensive and versatile expertise as a Colorectal Cancer Surgeon. This is validated by the successful cases of patients that she has dealt with.

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