Pressurized intraperitoneal aerosol chemotherapy (PIPAC) in patients with peritoneal surface malignancies (PSM): a prospective single-center registry study

Abstract Purpose Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new, palliative approach for patients with peritoneal surface malignancies (PSMs). Its main goals are to control symptoms and ascites. For this experimental procedure, treatment efficacy and patient safety need to be closely monitored. Methods We performed a prospective registry study for patients with PSMs. Cisplatin (C) (7.5 mg/m 2 body surface) and doxorubicin (D) (1.5 mg/m 2 ) were administered laparoscopically via PIPAC. Results Between November 2015 and June 2020, we recorded data from 108 patients and 230 scheduled procedures. Tumor burden, patient fitness, quality of life, operating time and in-hospital stay remained stable over consecutive procedures. We recorded 21 non-access situations and 14 intraoperative complications (11 intestinal injuries, and three aspirations while inducing anesthesia). Three or more previous abdominal surgeries or cytoreductive surgery (CRS) with intraperitoneal hyperthermic chemoperfusion (HIPEC) were risk factors for non-access and intestinal injuries (χ 2 , p ≤ 0.01). Five Grade IV and three Grade V postoperative complications according to the Clavien–Dindo Classification (CDC) occurred. Median overall survival was 264 days (interquartile range 108–586). Therapies were primarily discontinued because of death (34%), progressive (26%), or regressive (16%) disease. Conclusion PIPAC is effective in stabilizing PSMs and retaining quality of life in selected patients. Earlier abdominal surgeries and CRS with HIPEC should be considered when determining the indication for PIPAC. Randomized controlled studies are needed to evaluate PIPAC’s therapeutic benefits compared to systemic chemotherapy (sCHT) alone. Trial registration NCT03100708 (April 2017).