{"id":2115,"date":"2022-06-16T08:42:20","date_gmt":"2022-06-16T08:42:20","guid":{"rendered":"https:\/\/www.viamedsalud.com\/ivoqa\/pipac\/"},"modified":"2024-10-03T11:50:47","modified_gmt":"2024-10-03T11:50:47","slug":"pipac","status":"publish","type":"page","link":"https:\/\/www.viamedsalud.com\/ivoqa\/en\/pipac\/","title":{"rendered":"PIPAC"},"content":{"rendered":"\t\t
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VIAMED INSTITUTE OF ADVANCED SURGICAL ONCOLOGY<\/div>

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PIPAC (Pressurised Intra Peritoneal
Aerosolised Chemotherapy) <\/p>\n<\/h1><\/div><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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What is PIPAC?<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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PIPAC<\/strong> stands for Pressurised Intra Peritoneal Aerosolised Chemotherapy, and it is a treatment we offer to patients whose cancer has spread to their abdomen who, until recently, could only be offered palliative treatment<\/p>\n

What does the PIPAC procedure involve?<\/p>\n

PIPAC is a minimally invasive procedure, which is why it is very well tolerated by patients.<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t

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What does the PIPAC procedure involve?<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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PIPAC is a minimally invasive procedure, which is why it is very well tolerated by patients.<\/strong><\/div>\n
With laparoscopic surgery under general anaesthesia, we access the abdomen making 2 or 3 incisions of approximately one cm. These tiny incisions are sufficient to:<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Explore the entire abdomen<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Record a video documenting the extent of the disease and how it responds to PIPAC treatment<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t

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Take biopsies and cytology for our specialist pathologists to analyse the effect of PIPAC treatment<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Apply chemotherapy in the form of a pressurised aerosol or spray, thanks to which we improve penetration in the tumour nodules, without the chemotherapy passing into the blood (or a small amount), which is why we manage to avoid the harmful side effects of intravenous chemotherapy<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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After 30 minutes, the procedure is completed, the incisions are closed, and the patient returns comfortably to their room<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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The total time taken is usually less than 90 minutes<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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\u201cPIPAC is a great treatment option for patients with advanced cancer\u201d<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Thanks to the latest advances in medical research, at Viamed\u2019s Institute of Advanced Surgical Oncology, we offer a new therapeutic approach that is effective, less harmful, and preserves the patient\u2019s quality of life.<\/strong> Pressurised IntraPeritoneal Aerosolised Chemotherapy (PIPAC) allows chemotherapy to be administered in a minimally invasive way directly into the abdominal cavity.<\/div>\n
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Although PIPAC is a new treatment option, it is NOT an experimental treatment.<\/strong> More than 2,000 procedures have already been carried out in specialist European centres with promising results. The tumour response rate and slowing of tumour progression have been demonstrated, and prolongation of survival seems likely in patients who have benefited from this new procedure.<\/strong> Fortunately, this minimally invasive procedure is associated with a low level of side effects and acceptable surgical risks.<\/div>\n
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Following multidisciplinary discussion and the evaluation of alternatives in a personalised way for each patient, the team of professionals at IVOQA offers treatment with PIPAC.<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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Which patients can be treated?<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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It is a curative treatment for patients with advanced cancer that has spread to the peritoneum. This is known as peritoneal carcinomatosis or peritoneal metastases.<\/p>\n

The primary tumour may be located:<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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Abdomen<\/h3>

Stomach, colon, small intestine, ovary, pancreas, endometrium, appendix (one of its variants is peritoneal pseudomyxoma), sarcoma, cholangiocarcinoma, kidney cancer.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t

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Outside the abdomen<\/h3>

Lung cancer, breast cancer, melanoma.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t

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In the peritoneum itself<\/h3>

Peritoneal mesothelioma, primary peritoneal cancer.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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What are the results of PIPAC?<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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PIPAC offers very promising results in slowing disease progression, reducing symptoms, and prolonging life.<\/p>\n

Approximately 16% of patients treated with PIPAC have such a significant response that they may end up being treated with surgery and HIPEC.<\/p>\n

The percentage of patients with very advanced disease in the peritoneum, who are not eligible for HIPEC due to advanced nature of the cancer and its resistance to chemotherapy in which we obtain a response is<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Up to 88% in ovarian cancer<\/div>\t\t\t
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Up to 91% of patients with stomach cancer <\/div>\t\t\t
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Up to 86% of patients with colon cancer <\/div>\t\t\t
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Up to 75% of patients with Peritoneal Mesothelioma <\/div>\t\t\t
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Why should I undergo PIPAC treatment at Hospital Viamed Santa Elena?<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Due to their experience and number of cases treated, both in Spain and abroad, the IVOQA team are leading professionals in the PIPAC procedure. Dr. Delia Cort\u00e9s G\u00fciral has been certified to perform PIPAC since 2016, is a member of the PIPAC international instructor team and has trained many surgeons from around the world through official PIPAC courses in different countries (Singapore, UAE, Switzerland, Saudi Arabia, France, Israel\u2026) both face-to-face and online.<\/p>

Both she and her team offer high-level care to patients worldwide with carcinomatosis or peritoneal metastases.<\/p>

Dr. Cort\u00e9s directs the first and only international course in the treatment of peritoneal disease using minimally invasive techniques: laparoscopic peritonectomy, laparoscopic HIPEC, PIPAC (organised within the official courses of the European Society of Surgical Oncology \u2013 ESSO).<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t

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Nanoparticles<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Taxanes are one of the most useful families of anticancer drugs. To reduce toxicity and improve efficacy, new formulations of soluble nanoparticles have been developed. One such formulation is albumin-bound nanoparticles in water, stabilised with albumin and without a cremophore. This formulation has better solubility and less toxicity compared to previous versions.<\/p>


In addition, this nanoparticle formulation can be administered at higher doses and concentrations. Due to its superior clinical efficacy and safety profile, it received FDA approval for metastatic breast cancer in 2008 and for non-small cell lung cancer in 2011.<\/p>


Among gastrointestinal cancers, it is now approved in the US for the treatment of patients with metastatic pancreatic adenocarcinoma as first-line therapy in combination with another agent. In addition, several clinical trials have suggested the potential efficacy of this formulation as a single agent or in combination with other agents for the treatment of metastatic oesophageal, gastric, intestinal and biliary tract cancers.<\/p>

This formulation has been shown to have higher overall response rates, with increased progression-free survival, overall survival and a superior safety profile with fewer adverse effects in patients with cancers of the gastrointestinal tract.<\/p>


The use of these nanoparticles for PIPAC treatment for patients with peritoneal metastases or unresectable peritoneal carcinomatosis was described in the prestigious scientific journal The Lancet. In this rigorous work they found that PIPAC in this formulation was well tolerated and defined appropriate treatment doses according to patient conditions.<\/p>

Pharmacokinetic analysis demonstrated a slow elimination of the drug from the peritoneal cavity and how the amount of drug accumulated in the tumour tissue after repeated treatments with PIPAC. Patients’ quality of life remained stable and a promising anticancer response was observed.<\/p><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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PIPAC with nanoparticles carried out in our IVOQA Madrid centre (Hospital Viamed Santa Elena)<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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At IVOQA (Viamed Institute of Advanced Surgical Oncology) we have been pioneers in Spain in carrying out treatment with soluble nanoparticles and PIPAC for patients with unresectable peritoneal carcinomatosis originating in cancer of the stomach, ovary, small intestine, colon, appendix… confirming that it is very well tolerated by patients and with adequate anti-tumour activity.<\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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Laparoscopy image in IVOQA Madrid of a patient with non-operable peritoneal carcinomatosis due to its spread, originating in an adenocarcinoma of the appendix. The image above shows the involvement of the right diaphragm peritoneum (through multiple white implants) before treatment. The image below shows the response to 2 treatments of soluble nanoparticle PIPAC with decreased implant size.<\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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During each PIPAC or ePIPAC treatment, a video is made to assess the macroscopic response, and biopsies and cytology are taken so pathologists can assess the degree of peritoneal response to treatment (PRGS scale)<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t
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Do not hesitate to request an appointment with our specialists<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\tGet to know us<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tWill I feel pain after the PIPAC procedure?<\/a>\n\t\t\t\t\t<\/h3>\n\n\t\t\t\t\t

The PIPAC procedure is well tolerated. Thanks to the analgesia administered by our anaesthesiologists, you will not feel pain, only slight discomfort<\/p>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tHow long will I be in the hospital?<\/a>\n\t\t\t\t\t<\/h3>\n\n\t\t\t\t\t

You can return home the day after surgery.<\/p>\n

Patients coming from abroad can return to their hotel the next day and have to wait a few days before they can travel by plane.<\/p>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tWhat will I feel after each procedure?<\/a>\n\t\t\t\t\t<\/h3>\n\n\t\t\t\t\t

PIPAC will help you maintain your quality of life even if the tumour is very advanced, and in a large percentage of patients, PIPAC controls the formation of ascites (fluid build-up in the abdomen). Therefore, the abdominal swelling and discomfort resulting from ascites will improve or disappear in a large number of cases.<\/p>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tHow many PIPAC sessions are required?<\/a>\n\t\t\t\t\t<\/h3>\n\n\t\t\t\t\t

We currently recommend 3 PIPAC sessions, one every 6 weeks,<\/p>\n

if possible having two cycles of systemic chemotherapy between each PIPAC.<\/p>\n

There are also patients in special situations or who do not tolerate intravenous chemotherapy, in which case they are only treated with PIPAC with different frequencies.<\/p>\n

All patients who benefit from this new procedure are registered in an international database for their safety and benefit from highly structured post-operative follow-ups.<\/p>\n

The personal data collected will be processed in a strictly confidential manner and will be anonymised.<\/p>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\tWhat are the possible side effects?<\/a>\n\t\t\t\t\t<\/h3>\n\n\t\t\t\t\t

All interventions come with possible adverse effects.<\/p>\n

In the case of PIPAC, they are<\/p>\n

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  • Common (50%): Fever, abdominal scar pain, nausea.<\/li>\n
  • Rare (1%): Intestinal injury during the use of trochars or from biopsies.<\/li>\n
  • Very rare: Toxic skin reaction, risk of metastasis at the sites where trochars are used.<\/li>\n<\/ul>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t