Second Surgery and Pressure Chemotherapy (PIPAC/HIPEC) for Pancreatic Cancer: When, For Whom, Why?

Summary

Prof. Dr. Ünal Aydın's video discusses the possibility of a second surgery in patients who develop a recurrence of pancreatic cancer after the first surgery, and the use of pressure/heat chemotherapy approaches (PIPAC and HIPEC) in selected cases with peritoneal spread. The message: Every case is unique; decisions are made by a multidisciplinary tumor board .

When Should a Second Surgery Be Considered?

• If there is local recurrence and no distant organ metastasis

• If the general performance status is good

• If imaging (CT, MRI, PET-CT) and CA 19-9 biomarkers support a second surgery

• If the tumor appears technically clearable (R0 resection)

Purpose: To extend life expectancy and disease-free period in selected patients.

Difference Between PIPAC and HIPEC

• HIPEC: Warm chemotherapy fluid is circulated into the abdomen after major surgery.

• PIPAC: Chemotherapy is administered laparoscopically into the abdomen as a pressurized aerosol and can be administered in sessions.

Which Patients May Be Candidates?

• Those with limited peritoneal spread and no distant metastases

• Those who are in good general health

• Those deemed appropriate by the tumor council

Benefits and Risks

Benefits:

• Chance of removal with second surgery in selected recurrent cases

• More homogeneous drug distribution with PIPAC, relatively fewer systemic side effects

• Contribution to quality and duration of life in some studies

Risks:

• Complications of major surgery

• Chemotherapy-related toxicities

• Risk of early recurrence due to the biology of the disease

Frequently Asked Questions

Is the second surgery applicable to everyone?

No. It is not suitable in cases of distant metastasis, vascular/organ invasion or poor performance.

Are PIPAC and HIPEC the same thing?

No. HIPEC is hot liquid, PIPAC is pressurized aerosol application.

What are the side effects like?

Systemic side effects may be relatively less with PIPAC, but both methods have risks related to surgery and chemotherapy.