Department of General Surgery and Surgical Oncology, Archet 2 University Hospital, Nice, France.
Department of Digestive Surgery and Liver Transplantation, Archet 2 University Hospital, Nice, France.
Surg Endosc. 2020 Jun;34(6):2803-2806. doi: 10.1007/s00464-020-07488-6. Epub 2020 Mar 12.
Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new intraabdominal technique to approach non-resectable peritoneal carcinomatosis (PC). PIPAC can be performed alone or alternated with systemic chemotherapy to increase tumor regression. We describe our initial experience performed in an expert hyperthermic intraperitoneal chemotherapy (HIPEC) French center to demonstrate the safety and the feasibility of PIPAC.
Between January 2016 and March 2019, PIPAC was proposed to 43 consecutive patients affected by digestive, ovarian, peritoneal and mammary carcinomatosis. Initially PIPAC was proposed to patients non eligible for cytoreductive surgery for palliative purposes. In five patients we associated PIPAC to systemic chemotherapy to improve tumor regression and enhance the chance of patients to undergo HIPEC. Three PIPAC treatments were supposed to be performed for each patient with an interval of 6 weeks in between each procedure. Peritoneal biopsies were always performed to evaluate microscopic tumor regression. In case of postoperative clinical deterioration or quick tumor progression during the cycles, PIPAC was interrupted. Depending on the primary tumor, chemotherapies used were oxaliplatin or a combination of cisplatin and doxorubicin.
Twenty-six (60.4%) patients have already had a surgical resection or intervention of primary cancer removal. In 5 patients abdominal access was impossible. Of the 38 patients operated, seventy-one procedures were performed. In the series, one patient died because of tumor progression. Only one major complication occurred intraoperatively. Two of thirteen patients receiving oxaliplatin had postoperative abdominal pain and needed more drugs assumption and a longer hospitalization. Three patients after a three cycles procedure underwent HIPEC. Nine of the patients who had at least two PIPACs had last biopsies showing a major or complete tumor response.
PIPAC is a safe and feasible procedure that can be performed in patients with peritoneal carcinomatosis initially not eligible for surgery to reduce tumor invasion or for palliation to reduce symptoms. Contraindications are bowel obstruction and multiple intraabdominal adhesions.
加压腹腔内气溶胶化疗（PIPAC）是一种新的腹腔内技术，用于治疗不可切除的腹膜癌病（PC）。PIPAC 可单独进行，也可与全身化疗交替进行，以增加肿瘤消退。我们在一个专家级的腹腔内热化疗（HIPEC）法国中心进行了初步经验描述，以证明 PIPAC 的安全性和可行性。
2016 年 1 月至 2019 年 3 月，43 例患有消化道、卵巢、腹膜和乳腺癌病的连续患者被建议接受 PIPAC 治疗。最初，PIPAC 是为那些因姑息性目的而不适合进行细胞减灭术的患者提出的。在 5 例患者中，我们将 PIPAC 与全身化疗相结合，以提高肿瘤消退率，并增加患者接受 HIPEC 的机会。每位患者预计要进行 3 次 PIPAC 治疗，每次治疗间隔 6 周。始终进行腹膜活检以评估微观肿瘤消退情况。如果在周期中出现术后临床恶化或肿瘤快速进展，将中断 PIPAC。根据原发性肿瘤，使用的化疗药物为奥沙利铂或顺铂和多柔比星的联合用药。
26 例（60.4%）患者已经接受了手术切除或原发性癌症切除干预。在 5 例患者中，腹部通道无法进入。在接受手术的 38 例患者中，共进行了 71 次手术。在该系列中，1 例患者因肿瘤进展而死亡。仅 1 例患者在术中发生严重并发症。接受奥沙利铂治疗的 13 例患者中有 2 例术后出现腹痛，需要更多药物治疗并延长住院时间。3 例患者在进行了 3 个周期的治疗后接受了 HIPEC。至少接受了 2 次 PIPAC 治疗的 9 例患者的最后活检显示出主要或完全的肿瘤反应。
PIPAC 是一种安全可行的治疗方法，适用于最初不适合手术治疗以减轻肿瘤侵袭或缓解症状的腹膜癌病患者。禁忌证为肠梗阻和多腹腔粘连。
