Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) in patients with peritoneal metastasized colorectal, appendiceal and small bowel cancer

Background: Patients with intestinal cancer (colorectal, appendiceal, and small bowel) with peritoneal metastases (PM) have a poor prognosis. We assessed whether pressurized intraperitoneal aerosol chemotherapy (PIPAC) together with systemic chemotherapy is an effective treatment option for these entities in palliative intent. Methods: Between November 2015 and February 2018, prospective data registry was performed (NCT03100708). Thirteen patients with intestinal cancer (median age 61 years [range 49–77]) underwent 26 PIPAC procedures with a median number of 2 interventions per patient (range 1–6). A chemoaerosol consisting of cisplatin/doxorubicin was administered during standard laparoscopy. Results: The median peritoneal carcinomatosis index according to Sugarbaker before the first PIPAC was 14 (range 2–27), and the median ascites volume was 10 mL (range 0–6300 mL). Six patients who received 2 or more PIPAC procedures had decreased and stable ascites volumes, while only 1 patient displayed increased ascites. The median overall survival was 303 days (range 30–490) after the first PIPAC procedure. Conclusions: PIPAC offers a novel treatment option for patients with PM. Our data show that PIPAC is safe and well-tolerated. Ascites production can be controlled by PIPAC in patients with intestinal cancer. Further studies are required to document the significance of PIPAC within palliative therapy concepts. Trial registration: NCT03100708