Ceelen, Wim

Cosyns, Sarah

Van de Sande, Leen

Willaert, Wouter

Ghent University Academic Bibliography

Pressurized intraperitoneal aerosol chemotherapy (PIPAC),a new surgical technique for the treatment of unresectableperitoneal carcinomatosis.BackgroundPatients with unresectable peritoneal carcinomatosis treated with systemic chemotherapeutics havea bad prognosis. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) can be a valuableadjunct. PIPAC is a minimally invasive and repeatable technique to deliver chemotherapeutic drugsinto the peritoneal cavity. We report about the practical organization and implementation of thistechnique, its indications and its impact on patients’ early postoperative recovery.Cosyns Sarah (PhD, MSc), Van de Sande Leen (Msc), Ceelen Wim (FACS, MD, PhD), Willaert Wouter (MD, PhD),Department of Surgery, Ghent University Hospital, Ghent, Belgium. Corresponding author: sarah.cosyns@ugent.be.MethodsEvery practical step until the first procedure was retrospectively reviewed together with theindications to perform this technique, the number of procedures in each patient and the earlypostoperative recovery.PIPAC technique (Solass et al., 2014)ResultsConclusionPIPAC is a new surgical procedure for the treatment of unresectable peritoneal carcinomatosis. This technique is safe for the surgical teamunder controlled circumstances. Its practical implementation requires extensive teamwork. The impact of this chemotherapeutic procedure onpatients’ postoperative recovery is limited. In the near future, we will start with an experimental study on PIPAC.Tumor NumberColon adenocarcinoma 7Gastric adenocarcinoma 6Serous ovarian carcinoma 3Esophageal adenocarcinoma 2Gall bladder carcinoma 1Ductal breast carcinoma 1Mesothelioma 1Small bowel adenocarcinoma 1MANEC 1LAMN 1CUP 1PIPACs at Ghent University Hospital** Data collected over a period of 13 months: 49 procedures in 25 patients(9 patients underwent 3 procedures, 6 patients underwent 2 procedures, 10patients underwent 1 procedure). Surgeries occurred uneventful.Concomitant chemotherapy: n = 11; Laparotomy: n = 4Postoperative recoveryMainly uneventful:• Local pain• Subileus• Nausea• CRP increase (2-3 days postop: 100-150 mg/l)• FeverOne patient developed toxic inflammation of the abdominal wall (which was successfully treated with antibiotics)Safety measures: standard operating procedures strictly implemented!ProtectionClosed systemRemote controlSafety checklist Air contamination? Air sampling in the operating room during 2 PIPAC proceduresPlatinum concentrations were not increased• Not eligible for cytoreductivesurgery + HIPEC• Palliative systemicchemotherapy relapse or non-respondersIndications for PIPACEffect of Electrostatic Precipitation (E)PIPAC on peritoneal carcinomatosis in a patient with MANECDiffuse peritoneal carcinomatosis (white star) in the right hypochondrium before EPIPAC (A). Gradual blurring ofperitoneal carcinomatosis and development of adhesions between the right liver lobe and peritoneum of the rightdiaphragmatic dome (white star) during consecutive EPIPACs (B,C). Peritoneal carcinomatosis at the leftdiaphragmatic dome (black star) remains stable after 2 EPIPACs, but ascites appears in the left hypochondrium (whitearrow) (D,E,F).

Pressurized intraperitoneal aerosol chemotherapy (PIPAC), a new surgical technique for the treatment of unresectable peritoneal carcinomatosis

https://biblio.ugent.be/publication/8174530/file/8174579

Pressurized intraperitoneal aerosol chemotherapy (PIPAC), a new surgical technique for the treatment of unresectable peritoneal carcinomatosis

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Ghent University Academic Bibliography