Is PIPAC a very risky procedure?

Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) is a relatively new treatment option for patients with advanced abdominal cancers. Like with any new procedure, many people are afraid that there may be complications and high risks associated with it. Since it is a palliative procedure, which means that we try to extend the life of the individual as well as better the quality of life and not to cure the disease, it is very important that the risk involved with the procedure be acceptable.

Acceptable risk implies that the risk-benefit ratio has been taken into consideration and scale tips in favour of benefit, i.e. the benefit outweighs the risk. The safety of the procedure has been well established through multiple scientific studies and is well documented. The efficacy is also being established, with numerous ongoing trials showing promise.

Therefore, for cancers like ovarian cancer, stomach cancer, colorectal cancer, pseudomyxoma, mesothelioma, as well as other abdominal cancers, PIPAC  may play a very important role in palliation, especially if systemic chemotherapy is no longer effective. The rationale is that the drug given through the blood may not able to reach the tumour site. Cancer finds ways to dodge drugs. In PIPAC, chemotherapy is directly instilled in an aerosolized form into the abdominal cavity so that the chemotherapeutic drugs have a chance to kill the cancer cells through direct contact. The aerosol also has the advantage of being able to reach areas of tumour which would be otherwise hard to reach if the drugs were in liquid form.

So although the procedure is performed under general anaesthesia with the assistance of a laparoscope, the risk is minimal and well within acceptable limits in most patients. If your oncologist suggests this procedure, and everyone is convinced about its utility, it makes sense to go through with this procedure without too much apprehension about the risk.