Late-stage abdominal cancers are hard to treat – but an innovative surgical treatment known as PIPAC is offering patients an improved outlook.
“When cancers spread throughout the abdominal cavity, they travel in small nodules and get dispersed throughout the abdomen,” says Richard Berri, M.D., a surgical oncologist at Henry Ford Health. “If you can imagine taking sand and throwing it on a table, it would be difficult to pick up every piece. That’s kind of what a tumor does inside of the abdomen – sometimes you can’t surgically remove all of it.”
But PIPAC – short for pressurized intraperitoneal aerosolized chemotherapy – can help destroy these small nodules. It’s a minimally invasive surgery that sends chemotherapy directly into the abdominal cavity. During surgery, the surgeon makes two small incisions about 1 to 2 centimeters in size. Liquid chemotherapy is then delivered into the abdomen via a nebulizer, a device that uses pressure to turn it into a mist. The nebulizer stays in the abdomen for 30 minutes and diffuses chemotherapy throughout.
High pressure allows a lower dose of chemotherapy to be used – leading to lessened side effects – all while deeply penetrating cancer cells to destroy them. Most patients receive three PIPAC treatments, spaced six to eight weeks apart. Each time, the tumor is biopsied to understand how the treatment affected the tumor. Each procedure takes about two hours, the patient goes home the next day and they can return to other treatments right away.
Cancer Care At Henry Ford Health
PIPAC + HIPEC: Increasing Treatment Options For Metastatic Abdominal Cancer
A successful PIPAC surgery slows the growth of the tumor to prolong survival. In some cases, PIPAC can also be used as a ‘bridge’ treatment, allowing patients to undergo a larger surgery called HIPEC, short for hyperthermic intraperitoneal chemotherapy. (Initially, patients may not be in physical condition to undergo HIPEC, which is a benefit of the minimally invasive PIPAC.)
“HIPEC is another innovative treatment that destroys cancer cells by heating chemotherapy to 109.4 degrees Fahrenheit,” says Dr. Berri. HIPEC is a two-step procedure: tumors are first surgically removed. Then, heated chemotherapy is delivered directly into the abdomen to destroy any remaining cancer cells. It takes longer than PIPAC and requires a longer recovery in the hospital, but studies show HIPEC can improve survival and quality of life.
“Both PIPAC and HIPEC add to the variety of treatment options for patients with advanced abdominal cancers,” says Dr. Berri. “Every patient is different and it’s important to determine what is best for that particular person in an effort to prolong survival and improve quality of life.”
Reviewed by Richard Berri, M.D., Chief of Surgical Oncology and director of the HIPEC program at Henry Ford St. John Hospital. Dr. Berri is a nationally recognized expert in HIPEC and has built the largest HIPEC program in the state of Michigan. He performed the first PIPAC surgery in Michigan earlier this year.
