Use of PIPAC and HIPEC in Abdominal Cancer Treatment

This text is an article that explains the innovative techniques of PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy) and HIPEC (Hyperthermic Intraperitoneal Chemotherapy) for the treatment of abdominal cancers, especially in cases of peritoneal carcinomatosis.

Here is a summarized translation of the entire article:

Innovative Approaches in Abdominal Cancer Treatment: PIPAC and HIPEC

Innovative techniques used in the treatment of abdominal cancers play a critical role in increasing patients' lifespan and quality of life. PIPAC (Pressurized Intraoperative Aerosol Chemotherapy) and HIPEC (Hyperthermic Intraperitoneal Chemotherapy) are two significant methods in this field. This article will detail the basic features, advantages, challenges, and clinical applications of both methods.

1. Abdominal Cancers and Peritoneal Carcinomatosis

General Characteristics of Abdominal Cancers

Abdominal cancers are a group of cancers that develop within the abdominal cavity, often affecting organs such as the stomach, colon, pancreas, and liver. Peritoneal carcinomatosis is a type of metastasis seen in the advanced stages of abdominal organ cancers, where the cancer spreads to the lining of the abdomen (peritoneum). In this condition, traditional chemotherapy methods are often of limited effectiveness.

Challenges in Peritoneal Carcinomatosis

• Difficulty for traditional chemotherapy to reach peritoneal tissues.

• High systemic toxicity.

• Risk of cancer recurrence after surgical intervention.

These challenges have encouraged the development of regional chemotherapy methods like PIPAC and HIPEC.

2. PIPAC: An Innovative Approach

What is PIPAC?

PIPAC is a technique that allows for the application of chemotherapy drugs into the peritoneal cavity as a pressurized aerosol. This method is performed using minimally invasive surgical techniques, ensuring the drugs reach cancerous tissues directly.

How is PIPAC Applied?

1. Access to the abdominal cavity is gained through laparoscopic surgery.

2. Chemotherapy drugs are delivered into the peritoneal cavity as a high-pressure aerosol.

3. The drugs penetrate deeply into the tissues due to the pressure effect.

Advantages of PIPAC

• Less Systemic Toxicity: Since the drugs are applied locally, systemic side effects are minimal.

• Targeted Effect: Chemotherapy is focused directly on the tumorous tissues.

• Minimally Invasive: Performed with small incisions, which allows for faster recovery.

• Repeatable: Patients can receive PIPAC applications multiple times.

Clinical Use

PIPAC has been found effective, especially in cases of stomach, colon, ovarian cancers, and mesothelioma. It shows promising results in advanced-stage peritoneal carcinomatosis cases.

3. HIPEC: The Power of Heat and Chemotherapy

What is HIPEC?

HIPEC is a method where a heated chemotherapy solution is applied to the peritoneal cavity during surgery. It provides effective results when used in combination with cytoreductive surgery (CRS). This method targets microscopic cancer cells left behind after surgery.

How is HIPEC Applied?

1. Surgical removal of cancerous tissues (cytoreductive surgery) is performed.

2. A heated chemotherapy solution is applied to the peritoneal cavity.

3. The solution is circulated within the abdomen for a specific period (usually 60-90 minutes).

Advantages of HIPEC

• Hyperthermic Effect: Heat increases the sensitivity of cancer cells to the drugs.

• Local Chemotherapy: The drugs are delivered directly to the cancerous tissues.

• Elimination of Microscopic Cells: Cleans up cancer cells remaining after surgery.

Clinical Use

HIPEC is widely used for cancer types such as colon cancer, ovarian cancer, and peritoneal mesothelioma. When combined with cytoreductive surgery, it increases long-term survival rates.

4. Comparison of PIPAC and HIPEC

Criterion	PIPAC	HIPEC
Application Method	Chemotherapy in aerosol form	Heated liquid chemotherapy
Type of Surgery	Minimally invasive	Combined with open surgery
Repeatability	Yes, easily repeatable	Usually applied once
Treatment Goals	Reducing tumor burden in advanced cases	Eliminating microscopic tumor cells
Advantages	Less toxicity, minimally invasive	Enhanced chemotherapy effect with hyperthermia

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5. Patient Selection: Which Method is Right for Which Patient?

Each of PIPAC and HIPEC is advantageous for specific patient groups. Patient selection is made based on the type and stage of cancer, the patient's general health, and treatment goals.

Patients Suitable for PIPAC

• Advanced-stage patients for whom surgical intervention is not possible.

• Patients who have previously received systemic chemotherapy but had an insufficient response.

Patients Suitable for HIPEC

• Patients with surgically removable tumors.

• Cases where the cancer is confined to the peritoneal cavity.

6. The Future of PIPAC and HIPEC

Research and Innovations

• Artificial Intelligence and Imaging Technologies: Used in the planning and application of PIPAC and HIPEC procedures.

• New Chemotherapy Drugs: The development of more effective and less toxic drugs is increasing the efficacy of both methods.

Clinical Studies

• Clinical studies are investigating the effectiveness of combination treatments where PIPAC and HIPEC are used together.

• Protocols aimed at increasing long-term survival rates are being developed.

7. Conclusion: The Role of PIPAC and HIPEC in Cancer Treatment

PIPAC and HIPEC offer revolutionary innovations in the treatment of abdominal cancers. Both methods provide effective treatment options for challenging conditions like peritoneal carcinomatosis. With proper patient selection and treatment protocols, these innovative methods are making breakthroughs in cancer therapy.

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