Exploring PIPAC and HIPEC: Understanding the Differences

Peritoneal cancer, which develops in the thin layer of tissue that borders the abdomen, poses particular therapeutic problems owing to its large surface area and propensity to be discovered at an advanced stage. Traditionally treated with surgery and systemic chemotherapy, advances in medical research have resulted in the development of more focused medicines.

Among them, Pressurised Intraperitoneal Aerosol Chemotherapy (PIPAC) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) stand out as new methods to directly attack cancer cells in the peritoneal cavity.

Understanding the differences between PIPAC and HIPEC is critical not only for medical practitioners personalising treatments but also for patients making educated healthcare choices.

Understanding PIPAC

Pressurised Intraperitoneal Aerosol Chemotherapy (PIPAC) is a minimally invasive treatment that delivers chemotherapy as a pressurised aerosol straight into the abdominal cavity. This approach allows for increased local medication concentrations while minimising systemic exposure, possibly lowering adverse effects. PIPAC is essentially a palliative treatment for peritoenal metastasis that are not amenable for aggressive treatments like cytoreductive surgery and HIPEC.

• The Procedure

The PIPAC procedure uses laparoscopy, a surgical method performed via keyhole incisions, to inject chemotherapy medications in a  pressurised state, maximising their absorption by tumour cells. The belly is first inflated with carbon dioxide  to create space. The pressure of this gas  improves medication penetration of chemotherapeutic drugs that are sprayed in aerozole form,into tumour nodules ensuring direct cell kill.

• Benefits and Limitations

The advantages of PIPAC include:

• Less invasiveness.
• Tailored chemotherapy administration.
• Fewer systemic toxicity.
• The opportunity to repeat treatments at regular intervals.

However, there are limits; PIPAC is not appropriate for many patients. Notably,

1) Those with extensive  cancer spread or extenisive adhesions  in the abdomen ( from previous surgery)   that a working space cannot be created to inject aerosol 

2) Those with impending or clinical bowel obstruction 

3) Patients with poor general condition 

• Suitability for Different Types of Cancer Patients

PIPAC may be especially effective for individuals with peritoneal carcinomatosis who cannot take systemic chemotherapy or have had a limited response to traditional therapies and are not for CRS and HIPEC.

Its suitability varies depending on individual patient profiles, extent of disease, prior treatment history, and overall health. To achieve optimal patient treatment, oncologists must conduct a detailed assessment of these parameters. PIPAC is beneficial in intractable ascites.

Exploring HIPEC

Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a novel cytoreductive cancer treatment that follows the surgical excision of visible tumours in the abdominal cavity. To destroy leftover invisible microscopic cancer cells, a heated chemotherapeutic solution is circulated into the abdomen  for a short period.

• The Procedure

Following surgical debulking, HIPEC treatment involves circulating a heated chemotherapeutic solution, typically between 41℃ and 43℃, inside the peritoneal cavity.The choice of chemotherapeutic agent is based on type of cancer. This approach, which may take up to 90 minutes, tries to increase the drug’s cytotoxicity against residual cancer cells , using heat ,while minimising systemic exposure.

• Benefits and Limitations

HIPEC has various advantages, including enhanced efficacy owing to hyperthermia, direct interaction with cancer cells, and a decrease in systemic adverse effects. However, the cytoreductive surgery that is usually combined with HIPEC has certain disadvantages, such as being a lengthy surgical operation that requires extended recovery periods and may be inappropriate for individuals with substantial illness or low-performance status.

• Suitability for Different Types of Cancer Patients

HIPEC has been  examined for individuals with certain forms of abdominal malignancies, namely peritoneal carcinomatosis HIPEC has become standard of care in mesothelioma, ovarian cancer,gastric  and pseudomyxoma in several conoutries. To make an educated choice about using HIPEC in personalized cancer care regimens, oncologists must consider the severity of the illness, the patient’s state, and past therapies.

Comparing PIPAC with HIPEC.

HIPEC is essentially used for curative purpose and PIPAC for palliative intent. However, the indications are always evolving. PIPAC has been used to convert inoperable cases into operable cases thus changing outcomes dramatically.

While HIPEC is well known for treating peritoneal carcinomatosis, Pressurised IntraPeritoneal Aerosol Chemotherapy (PIPAC) has emerged as a less invasive option. Both treatments attempt to deliver chemotherapy directly to cancer cells in the abdominal cavity, but their tactics vary dramatically. 

PIPAC is a laparoscopic approach in which the chemotherapy is aerosolized and delivered under pressure to improve tissue penetration. This approach often takes numerous sessions, although it is less invasive than the one-time HIPEC operation. The aerosolized chemotherapy utilised in PIPAC is usually given at lower temperatures, eliminating the hyperthermic component of HIPEC. 

In terms of success rates, both therapies show promise for improving patient outcomes, although HIPEC has a larger body of data owing to its more extended history of clinical use. However, new research indicates that PIPAC may have a better side-effect profile, presumably due to decreased systemic drug exposure and repeated smaller dosing.

Oncologists and onco-surgeons must assess the risks and advantages of both operations, taking into account the patient’s general health, past therapies, and the nature of the illness. HIPEC may be favoured due to its one-time, intense approach in curative settings, but PIPAC may be appropriate for individuals who are unable to undergo  major surgery.

Both procedures need specialised equipment and technical knowledge. As research progresses, the indications, effectiveness, and practice recommendations for PIPAC and HIPEC will become more defined, allowing doctors to provide precise, personalised treatment to their patients.

Finally, PIPAC and HIPEC are at the cutting edge of intraperitoneal chemotherapy innovation, each with its own approach and clinical emphasis. PIPAC’s aerosolized, lower temperature technique is a less intrusive option with the potential for a better side effect profile. At the same time, HIPEC’s single intense session may help individuals who need rapid intervention.

A thorough evaluation of the particular patient’s condition, as well as the possible risks and advantages of each surgery, should be used to choose the best course of therapy. While HIPEC has more substantial proof, further research and clinical trials will shed light on PIPAC’s complete potential and best use cases.

Patients facing challenging treatment options for abdominal malignancies should consult with their oncologists, who may direct them to the most suitable, tailored medical care based on their unique clinical situation.

For expert guidance on PIPAC and HIPEC treatments, consult Dr. Praveen Kammar, a leading specialist in abdominal malignancies. Get personalized care tailored to your unique needs and navigate your treatment options with confidence!