PIPAC (Pressurised Intraperitoneal Aerosol Chemotherapy)

The peritoneum is the smooth lining of the abdominal cavity, and several cancers, including those of the ovary, stomach, bowel and appendix, can scatter deposits across it. When this spread is too widespread to remove completely, standard chemotherapy given through a vein often reaches these surface deposits poorly. PIPAC takes a different route. A small amount of chemotherapy is turned into an aerosol and sprayed into the sealed, gas-filled abdomen under controlled pressure. The pressure and the fine droplet size help the drug spread to all corners and soak into the lining more effectively than liquid placed in the abdomen, while the low dose keeps the amount entering the bloodstream small. The result is a targeted treatment that concentrates where the disease lives and spares much of the body the effects of stronger intravenous chemotherapy.

PIPAC is considered mainly for peritoneal carcinomatosis, meaning cancer that has spread widely across the abdominal lining and cannot be fully removed surgically. It is often used for peritoneal spread from ovarian, gastric, colorectal and appendiceal cancers, and for peritoneal mesothelioma, and it can help control the build-up of fluid in the abdomen known as malignant ascites. It may be offered as a treatment in its own right, alongside intravenous chemotherapy, or to assess and treat disease that is being watched closely. Because it is repeatable, it is frequently planned as a course of several sessions spaced a few weeks apart, with the response reviewed each time. The decision is made by a specialised peritoneal-surface team after reviewing the type and extent of the cancer, previous treatments and the person's general fitness.

The treatment is carried out under general anaesthesia using keyhole surgery. The surgeon makes two small openings in the abdominal wall and inflates the abdomen with gas, just as in other laparoscopic procedures, which also allows a careful inspection of the cavity and small biopsies if needed. A specialised nebuliser is then introduced, and the chemotherapy is released as a pressurised aerosol that fills the sealed abdomen for a set time, usually around thirty minutes, while the operating team monitors the process from outside under strict safety conditions. The aerosol is then safely extracted, the instruments are removed and the small incisions are closed. The whole session commonly takes about ninety minutes to two hours. Because the openings are tiny and no major organ removal is involved, discomfort afterwards is usually modest and recovery between sessions is relatively quick.

A suitable candidate has peritoneal-surface cancer that cannot be fully removed, is well enough for repeated short keyhole operations, and has had the disease reviewed by an experienced team. Preparation includes cross-sectional imaging of the abdomen and pelvis, blood tests, and a review of previous treatments and general fitness; if there has been earlier abdominal surgery, the team also considers how accessible the cavity is likely to be. Medicines, especially blood thinners, are reviewed and adjusted on medical advice. For international patients, the assessment can begin from home, with recent scans, pathology reports and a medical summary reviewed remotely so the team can advise on suitability before travel. Because PIPAC is usually given as a course, the team will also explain how the sessions are spaced so that travel and treatment can be planned together.

Recovery after a PIPAC session is generally quicker than after open abdominal surgery. Most people stay in hospital for about two to three days per session, and discomfort from the small incisions settles over the following days. Eating usually resumes soon after the procedure, and many return to normal activity within one to two weeks, which is also roughly the gap before the next session in a typical course. Planning treatment abroad, it helps to know whether a single session or a short series is intended, because a course may mean either a longer stay or planned return visits. Air travel is normally fine within a few days, once the team confirms a settled recovery. Follow-up imaging and reviews can often continue from home between or after sessions, and international patient teams commonly arrange interpreters and coordinators so communication is straightforward throughout.

PIPAC is a relatively new but established technique that is performed in specialised centres under strict safety procedures, because chemotherapy is being aerosolised in the operating room. For the patient it is generally well tolerated, with low rates of serious complications compared with major open surgery. Possible issues include abdominal pain, temporary nausea, mild effects on blood counts and, as with any keyhole procedure, small risks of bleeding or injury inside the abdomen. The main aim of PIPAC is control rather than cure: for suitable patients it can shrink or stabilise peritoneal disease, ease symptoms such as fluid build-up, and do so with a quality of life that allows treatment to continue over several sessions. Results depend on the type and extent of the cancer and on the experience of the team, which is why it is best carried out where peritoneal-surface disease is treated regularly.