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

Martin Hübner, Hugo Teixeira Farinha, Fabian Grass, Anita Wolfer, Patrice Mathevet, Dieter Hahnloser, Nicolas Demartines, Martin Hübner, Hugo Teixeira Farinha, Fabian Grass, Anita Wolfer, Patrice Mathevet, Dieter Hahnloser, Nicolas Demartines

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.

Conflict of interest statement

The authors declare that there is no conflict of interest regarding the publication of this paper.

Figures

Figure 1
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
Figure 2
Flow of patients treated with pressurized intraperitoneal aerosol chemotherapy (PIPAC).
Figure 3
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).

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