Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) As an Outpatient Procedure

Overview

Journal Pleura Peritoneum

Date 2019 Mar 27

PMID 30911669

Citations 18

Authors

Martin Graversen

Lars Lundell

Claus Fristrup

Per Pfeiffer

Michael B Mortensen

Affiliations

Soon will be listed here.

Abstract

Background: Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) is a drug-delivery method for patients with peritoneal metastasis (PM). The study objective was to investigate whether PIPAC is possible in an outpatient setting.

Methods: Data was extracted from the prospective PIPAC-OPC2 study (ClinicalTrials.gov NCT03287375). Patients with PM were treated by cisplatin and doxorubicin (PIPAC C/D), except patients with colorectal PM, who were treated by oxaliplatin (PIPAC OX). Patients were evaluated concerning the suitability for carrying out the PIPAC procedure in an out- patient setting. The preconditions for outpatient surgery were that the patient should be (1) freely mobilized, (2) adequately pain-relieved, (3) have untroubled urination and (4) without anxiety or discomfort caused by leaving the hospital.

Results: During the study period, 106 PIPAC procedures (79 PIPAC C/D, 27 PIPAC OX) were performed in 41 patients with gastrointestinal or ovarian PM. Ninety percent (37/41) of the patients were pretreated with systemic chemotherapy. Eight patients (20%) received bidirectional chemotherapy. Twenty-four percent (10/41) of the first PIPAC procedures were completed in an outpatient setting, which increased to 65% (13/20) in PIPAC no 3 (p=0.008). In the PIPAC C/D cohort, 28% and 80% of the PIPACs were performed in the outpatient setting at PIPAC 1 and 3 respectively, contrasting to only 11% and 20% in the PIPAC OX group. No readmissions after outpatient care. Postoperative morphine administration was more frequent in the PIPAC OX group.

Conclusions: The PIPAC procedure can be performed in an outpatient setting. The critical component for success is pain control.

Citing Articles

Outcome of patients with peritoneal metastasis from ovarian cancer treated with Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC).

Foslund I, von Magius S, Ainsworth A, Detlefsen S, Fristrup C, Knudsen A Pleura Peritoneum. 2024; 9(2):69-77.

PMID: 38948328 PMC: 11211650. DOI: 10.1515/pp-2023-0049.

Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) in the Treatment of Gastric Cancer: Feasibility, Efficacy and Safety-A Systematic Review and Meta-Analysis.

Ramalho-Vasconcelos F, Gomes R, Bouca-Machado R, Aral M, Nogueiro J, Bouca-Machado T J Clin Med. 2024; 13(11).

PMID: 38893031 PMC: 11173180. DOI: 10.3390/jcm13113320.

Comparing patient reported abdominal pain between patients treated with oxaliplatin-based pressurized intraperitoneal aerosol chemotherapy (PIPAC-OX) and primary colorectal cancer surgery.

van de Vlasakker V, Lurvink R, Wassenaar E, Rauwerdink P, Bakkers C, Rovers K Sci Rep. 2023; 13(1):20458.

PMID: 37993560 PMC: 10665337. DOI: 10.1038/s41598-023-47510-0.

PIPAC for Gastrointestinal Malignancies.

Daniel S, Sun B, Lee B J Clin Med. 2023; 12(21).

PMID: 37959264 PMC: 10650315. DOI: 10.3390/jcm12216799.

Mechanistic Insights on Hyperthermic Intraperitoneal Chemotherapy in Ovarian Cancer.

Huffman O, Chau D, Dinicu A, DeBernardo R, Reizes O Cancers (Basel). 2023; 15(5).

PMID: 36900195 PMC: 10000881. DOI: 10.3390/cancers15051402.

References

Reymond M, Demtroeder C, Solass W, Winnekendonk G, Tempfer C . Electrostatic precipitation Pressurized IntraPeritoneal Aerosol Chemotherapy (ePIPAC): first in-human application. Pleura Peritoneum. 2019; 1(2):109-116. PMC: 6386498. DOI: 10.1515/pp-2016-0005. View

Graversen M, Pedersen P, Mortensen M . Environmental safety during the administration of Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC). Pleura Peritoneum. 2019; 1(4):203-208. PMC: 6386395. DOI: 10.1515/pp-2016-0019. View

Bjerring O, Fristrup C, Mortensen M . Telephone hotline is an important part of overall patient management in upper gastrointestinal malignancies. Dan Med J. 2012; 59(8):A4487. View

Solass W, Kerb R, Murdter T, Giger-Pabst U, Strumberg D, Tempfer C . Intraperitoneal chemotherapy of peritoneal carcinomatosis using pressurized aerosol as an alternative to liquid solution: first evidence for efficacy. Ann Surg Oncol. 2013; 21(2):553-9. PMC: 3929768. DOI: 10.1245/s10434-013-3213-1. View

Elferink M, de Jong K, Klaase J, Siemerink E, de Wilt J . Metachronous metastases from colorectal cancer: a population-based study in North-East Netherlands. Int J Colorectal Dis. 2014; 30(2):205-12. DOI: 10.1007/s00384-014-2085-6. View

Solass W, Hetzel A, Nadiradze G, Sagynaliev E, Reymond M . Description of a novel approach for intraperitoneal drug delivery and the related device. Surg Endosc. 2012; 26(7):1849-55. DOI: 10.1007/s00464-012-2148-0. View

Hollingsworth J, Birkmeyer J, Ye Z, Miller D . Specialty-specific trends in the prevalence and distribution of outpatient surgery: implications for payment and delivery system reforms. Surg Innov. 2014; 21(6):560-5. DOI: 10.1177/1553350613520515. View

Nadiradze G, Giger-Pabst U, Zieren J, Strumberg D, Solass W, Reymond M . Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) with Low-Dose Cisplatin and Doxorubicin in Gastric Peritoneal Metastasis. J Gastrointest Surg. 2015; 20(2):367-73. PMC: 4722080. DOI: 10.1007/s11605-015-2995-9. View

Koenig L, Gu Q . Growth of ambulatory surgical centers, surgery volume, and savings to medicare. Am J Gastroenterol. 2013; 108(1):10-5. DOI: 10.1038/ajg.2012.183. View

10.

Tempfer C, Giger-Pabst U, Seebacher V, Petersen M, Dogan A, Rezniczek G . A phase I, single-arm, open-label, dose escalation study of intraperitoneal cisplatin and doxorubicin in patients with recurrent ovarian cancer and peritoneal carcinomatosis. Gynecol Oncol. 2018; 150(1):23-30. DOI: 10.1016/j.ygyno.2018.05.001. View

11.

Franko J, Shi Q, Meyers J, Maughan T, Adams R, Seymour M . Prognosis of patients with peritoneal metastatic colorectal cancer given systemic therapy: an analysis of individual patient data from prospective randomised trials from the Analysis and Research in Cancers of the Digestive System (ARCAD) database. Lancet Oncol. 2016; 17(12):1709-1719. DOI: 10.1016/S1470-2045(16)30500-9. View

12.

Grass F, Vuagniaux A, Teixeira-Farinha H, Lehmann K, Demartines N, Hubner M . Systematic review of pressurized intraperitoneal aerosol chemotherapy for the treatment of advanced peritoneal carcinomatosis. Br J Surg. 2017; 104(6):669-678. DOI: 10.1002/bjs.10521. View

13.

Bjerregaard J, Mortensen M, Schonnemann K, Pfeiffer P . Characteristics, therapy and outcome in an unselected and prospectively registered cohort of pancreatic cancer patients. Eur J Cancer. 2012; 49(1):98-105. DOI: 10.1016/j.ejca.2012.07.017. View

14.

Hubner M, Farinha H, Grass F, Wolfer A, Mathevet P, Hahnloser D . Feasibility and Safety of Pressurized Intraperitoneal Aerosol Chemotherapy for Peritoneal Carcinomatosis: A Retrospective Cohort Study. Gastroenterol Res Pract. 2017; 2017:6852749. PMC: 5346367. DOI: 10.1155/2017/6852749. View

15.

Tempfer C, Celik I, Solass W, Buerkle B, Pabst U, Zieren J . Activity of Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) with cisplatin and doxorubicin in women with recurrent, platinum-resistant ovarian cancer: preliminary clinical experience. Gynecol Oncol. 2013; 132(2):307-11. DOI: 10.1016/j.ygyno.2013.11.022. View

16.

Graversen M, Detlefsen S, Pfeiffer P, Lundell L, Mortensen M . Severe peritoneal sclerosis after repeated pressurized intraperitoneal aerosol chemotherapy with oxaliplatin (PIPAC OX): report of two cases and literature survey. Clin Exp Metastasis. 2018; 35(3):103-108. DOI: 10.1007/s10585-018-9895-9. View

17.

Graversen M, Detlefsen S, Bjerregaard J, Fristrup C, Pfeiffer P, Mortensen M . Prospective, single-center implementation and response evaluation of pressurized intraperitoneal aerosol chemotherapy (PIPAC) for peritoneal metastasis. Ther Adv Med Oncol. 2018; 10:1758835918777036. PMC: 5985602. DOI: 10.1177/1758835918777036. View

18.

Alyami M, Gagniere J, Sgarbura O, Cabelguenne D, Villeneuve L, Pezet D . Multicentric initial experience with the use of the pressurized intraperitoneal aerosol chemotherapy (PIPAC) in the management of unresectable peritoneal carcinomatosis. Eur J Surg Oncol. 2017; 43(11):2178-2183. DOI: 10.1016/j.ejso.2017.09.010. View

19.

Graversen M, Detlefsen S, Asmussen J, Mahdi B, Fristrup C, Pfeiffer P . Treatment of peritoneal carcinomatosis with Pressurized IntraPeritoneal Aerosol Chemotherapy - PIPAC-OPC2. Pleura Peritoneum. 2019; 3(2):20180108. PMC: 6404994. DOI: 10.1515/pp-2018-0108. View

20.

Robella M, Vaira M, De Simone M . Safety and feasibility of pressurized intraperitoneal aerosol chemotherapy (PIPAC) associated with systemic chemotherapy: an innovative approach to treat peritoneal carcinomatosis. World J Surg Oncol. 2016; 14:128. PMC: 4850728. DOI: 10.1186/s12957-016-0892-7. View