Pressurised intraperitoneal aerosol chemotherapy (PIPAC): the first Australian experience

Our plain-English summary of Pressurised intraperitoneal aerosol chemotherapy (PIPAC): the first Australian experience, by K. Foley, J. Reid, S. Edwards, et al (Pleura and Peritoneum, 2025).

The study

• Authors: K. Foley, J. Reid, S. Edwards, T. Price, A. Zimet, S. Woods, M. Trochsler, A.C. Lynch, P. Hewett
• Journal: Pleura and Peritoneum
• Published: 2025;10(1):25-31
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: Pressurised intraperitoneal aerosol chemotherapy (PIPAC) is a novel surgical technique for patients with peritoneal metastases not amenable to curative treatment. PIPAC delivers pressurised aerosolised chemotherapy using a hyperbaric capnoperitonem established laparoscopically. This study sought to investigate the feasibility and safety of PIPAC in an Australian population.

Methods: We undertook a cohort analysis of prospectively-collected data on patients undergoing PIPAC across two Australian hospitals. Participants were planned to have three PIPAC procedures, each 6 weeks apart. Study outcomes included post-operative complications including 30-day mortality, length of stay (LOS) and patient quality of life (EORTC QLQ-C30 scores).

Results: 18 patients underwent 50 completed procedures. 13 patients had two or more PIPACs. The most common primary malignancy was colorectal cancer (n=8), followed by gastric cancer (n=4), appendiceal cancer (n=4) and mesothelioma (n=2). One grade four but no grade five complications occurred, with zero 30-day mortality. Median LOS was 1 day. Mean EORTC QLQ-C30 score increased from 47.8 at baseline to 53 post second PIPAC. Due to the heterogeneity of our cohort, survival analysis and statistical comparisons were unable to be made.

Conclusion: PIPAC is feasible, safe and well tolerated in an Australian population with a lack of severe complications and zero 30 day mortality. Due to the small number of patients and the heterogeneity of our study's sample, it was not possible to perform survival analysis. The study is nonetheless valuable as the first investigation of implementation of PIPAC in Australia.

© 2025 the author(s), published by De Gruyter, Berlin/Boston.

In plain English

This study described the first Australian use of pressurised intraperitoneal aerosol chemotherapy (PIPAC), in which chemotherapy is sprayed as a pressurised aerosol into the abdomen during keyhole surgery. It was used for patients whose cancer had spread to the abdominal lining and who could not have curative surgery. The authors analysed prospectively collected records of 18 patients treated at two hospitals between December 2019 and April 2022. Two had mesothelioma; the article does not state its type and does not discuss asbestos. The patients had 50 completed procedures, and 13 had repeated procedures. There were 25 post-operative complications, most often abdominal pain (9) and nausea and vomiting (6). One was grade four (a stomach perforation repaired with sutures), and there were no deaths within 30 days. Median hospital stay was 1 day. Mean quality-of-life scores, collected at one hospital only, were 47.8 at baseline (9 respondents) and 53 after the second procedure (3 respondents). The authors concluded that PIPAC was safe and feasible in an Australian population. The small, mixed group prevented survival analysis or statistical comparisons.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective cohort analysis of prospectively collected data at two hospitals
• Who was studied: 18 adults with peritoneal metastases who were not candidates for cytoreductive surgery and HIPEC. Ten were treated at The Queen Elizabeth Hospital (South Australia) and eight at Epworth Health (Victoria), between December 2019 and April 2022. The primary cancers were colorectal, gastric, appendiceal and mesothelioma; two patients had mesothelioma, of a type the article does not specify.
• Exposure: The exposure studied was PIPAC treatment, using oxaliplatin, cisplatin, or cisplatin with doxorubicin. The article reports no asbestos exposure information.
• Main results:
  • 13 of the 18 patients (72.2 %) underwent repeated PIPAC procedures.
  • Across all patients there were 25 post-operative complications; the most frequent were abdominal pain (n=9) and nausea and vomiting (n=6).
  • There was one grade four complication, a gastric perforation on entering the abdomen that required suture repair. The 30-day mortality rate was zero.
  • Of the nine patients with significant post-operative pain, seven had received oxaliplatin and two had received cisplatin with or without doxorubicin.
  • Median post-operative length of stay was 1 day (range 0.5 to 8 days).
  • Quality of life was measured at The Queen Elizabeth Hospital only. The mean EORTC QLQ-C30 score was 47.8 at baseline (9 of 10 patients responded), 50.7 after the first PIPAC (7 responded) and 53 after the second PIPAC (3 responded).
  • Among the seven colorectal cancer patients who had repeated PIPACs, the PCI score (a measure of visible abdominal cancer spread) decreased in three, increased in one and was unchanged in three.
  • Five colorectal cancer patients had ascites (abdominal fluid) at the first PIPAC. Of these, three had an overall decrease in ascites volume from first to last PIPAC and two had an overall increase.
• The authors' conclusion: The authors concluded that they had shown PIPAC to be safe and feasible in an Australian population, with a lack of severe complications and zero 30-day mortality.
• Limitations the authors state:
  • The cohort mixed four different primary cancers, so the authors could not analyse survival or perform other statistical comparisons.
  • Quality of life was assessed at only one of the two hospitals, and fewer questionnaires were returned with each PIPAC cycle.
  • The authors note that the small sample size risks underestimating the effect of PIPAC.

Topics

Medical terms in this study, explained in our Lexicon: Chemotherapy, Quality of Life, Colorectal Cancer, Stomach Cancer, Mesothelioma.

Related studies

• Multicentric initial experience with the use of the pressurized intraperitoneal aerosol chemotherapy (PIPAC) in the management of unresectable peritoneal carcinomatosis — M. Alyami, J. Gagniere, et al. (2017)
• Pressurised intraperitoneal aerosol chemotherapy: rationale, evidence, and potential indications — M. Alyami, M. Hübner, et al. (2019)
• Quality of life of patients with end-stage peritoneal metastasis treated with Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) — K. Odendahl, W. Solass, et al. (2015)
• Multicenter comprehensive methodological and technical analysis of 832 pressurized intraperitoneal aerosol chemotherapy (PIPAC) interventions performed in 349 patients for peritoneal carcinomatosis treatment: An international survey study — M. Nowacki, M. Alyami, et al. (2018)
• Unresectable peritoneal metastasis treated by pressurized intraperitoneal aerosol chemotherapy (PIPAC) leading to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy — M. Alyami, F. Mercier, et al. (2021)
• Oxaliplatin use in pressurized intraperitoneal aerosol chemotherapy (PIPAC) is safe and effective: A multicenter study — O. Sgarbura, M. Hübner, et al. (2019)

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