Pressurized intraperitoneal aerosol chemotherapy (PIPAC)

من إعداد فريق مايو كلينك

What is pressurized intraperitoneal aerosol chemotherapy?

Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is an experimental treatment for cancers that have spread to the lining of the abdominal cavity, known as the peritoneum. The term "intraperitoneal" means the treatment is delivered directly inside the abdominal cavity, where the cancer is located. For now, PIPAC is considered palliative, meaning that it's used to help manage symptoms, not to cure the cancer.

PIPAC is the delivery of chemotherapy as a pressurized mist directly into the abdomen during a minimally invasive surgery called laparoscopy. The pressure helps the medicine absorb into the cancer tissue and spread more evenly. Unlike other treatments, PIPAC does not include surgical removal of the cancer. PIPAC is repeated about every six weeks, while you remain on whole-body, also called systemic, chemotherapy.

PIPAC was first used to relieve symptoms in people whose cancer no longer responded to other treatments. Today, doctors are also studying whether it can help extend life in people with cancer or prevent cancer from returning.

When is PIPAC used?

Healthcare professionals consider PIPAC for people with advanced peritoneal cancer when surgery to cure the cancer is not possible or when the cancer has gotten worse while traditional therapies are in use. PIPAC is less toxic than systemic chemotherapy and less invasive than open surgery.

PIPAC may be used to:

  • Slow or stop the cancer from spreading.
  • Shrink tumors so they are small enough to surgically remove. Up to 15% of people who received PIPAC in clinical trials were later able to have surgery to remove tumors.
  • Relieve symptoms such as fluid buildup in the belly, called ascites.
  • Reduce hospital stays and side effects. Compared with systemic chemotherapy alone, PIPAC in addition to systemic chemotherapy results in fewer and shorter hospitalizations, longer overall survival, and better quality of life.

What cancers does PIPAC treat?

PIPAC treats cancers that start in other organs but spread to the peritoneum. These are called peritoneal metastases. PIPAC is most commonly used to treat peritoneal metastases cancers such as:

  • Colon or rectal cancer.
  • Appendix cancer.
  • Stomach cancer.
  • Ovarian cancer.

How is PIPAC done?

PIPAC is done during a short surgery called laparoscopy. First, a small camera and special instruments are put into the abdomen through tiny cuts. Then, chemotherapy medicine is turned into a fine, aerosolized mist and sprayed inside the abdominal cavity using a high-pressure device.

During the procedure, the belly is gently inflated with a combination of carbon dioxide gas and chemotherapy medicine to create space and pressure. This helps the chemotherapy medicine spread evenly and go deeper into cancer tissue. The mist stays in the belly under pressure for about 30 minutes, then the gas is safely removed using a closed air waste evacuation system. The entire procedure takes about an hour and typically does not require a hospital stay. PIPAC can usually be repeated every 6 to 8 weeks.

What are the side effects of PIPAC?

Because PIPAC uses far lower doses than standard chemotherapy treatment, it's generally well tolerated. Most side effects are mild and temporary. They may include:

  • Abdominal pain or cramping.
  • Upset stomach or vomiting.
  • Bloating.
  • Temporary loss of appetite.
  • Changes in bowel habits, such as constipation or diarrhea.

Serious side effects are rare but can include:

  • Infection related to surgery.
  • Surgical complications, such as bowel or organ injury.
  • Scar tissue formation inside the abdomen, which may slow down or block the intestines as food moves through the body.

Most people go home the same day and recover within a week.

What is the success rate of PIPAC?

Success rates for PIPAC vary, as it's used for different cancers and in different situations. The chance of benefit is highest when PIPAC is repeated and the cancer is limited to the abdomen. Outcomes include:

  • Slowed or stopped cancer progression in about 50% to 75% of people with colon, rectal or ovarian cancer.
  • Improved quality of life for most people who have PIPAC.
  • Longer survival for people with colon, rectal or appendix cancers, compared with survival after systemic chemotherapy in some studies.
  • Better control of symptoms, such as abdominal fluid buildup, called ascites, in some people.

More studies are ongoing to better understand how well PIPAC works across different cancers and identify which people are likely to benefit the most.

Is cytoreductive surgery done before or after PIPAC?

Cytoreductive surgery (CRS) is a procedure to remove all visible cancer from the peritoneum and other organs in the abdomen. CRS also is known as debulking surgery.

People who have already had CRS can receive PIPAC. Sometimes, PIPAC can help shrink cancer enough that CRS becomes possible, even if healthcare professionals first thought the cancer was too widespread to remove.

PIPAC and HIPEC: What's the difference?

Pressurized intraperitoneal aerosol chemotherapy (PIPAC) and hyperthermic intraperitoneal chemotherapy (HIPEC) are both treatments that deliver chemotherapy directly into the abdominal cavity. However, the procedures have some key differences, including:

  • Surgery requirements:
    • HIPEC is usually given right after cytoreductive surgery (CRS), which is a major procedure. CRS is done to remove as much cancer as possible.
    • PIPAC is given during a short, minimally invasive laparoscopic procedure and does not require cancer removal.
  • Chemotherapy delivery:
    • HIPEC uses heated liquid chemotherapy that is poured into the abdominal cavity.
    • PIPAC uses a pressurized chemotherapy mist that spreads more evenly and penetrates deeper into cancer tissue.
  • Treatment schedule:
    • HIPEC is usually done once.
    • PIPAC can be repeated every 6 to 8 weeks.
  • Side effects and recovery:
    • HIPEC is more invasive and has a longer recovery time because it is combined with CRS.
    • PIPAC has fewer side effects and a quicker recovery time.
  • Outcomes:
    • HIPEC offers a potential cure.
    • PIPAC is considered palliative, meaning that it's used to help manage symptoms, not to cure the cancer.

Where are PIPAC procedures performed in the United States?

PIPAC is still a new treatment in the U.S. and is currently available only at a small number of specialized cancer centers. These centers have taken part in early U.S. clinical trials studying PIPAC for cancers such as those of the colon, rectum, appendix, stomach and ovaries.

Since PIPAC is still being studied, most procedures are done as part of clinical trials. Talk with your healthcare team to see whether a trial is available near you or whether you can get a referral.

Are there clinical trials for PIPAC?

Yes. There are several ongoing clinical trials for PIPAC in the United States and internationally. These trials are testing how safe and effective PIPAC is for different cancers that have spread to the abdominal cavity.

Some trials are testing PIPAC alone, while others are combining it with systemic chemotherapy. A few studies are exploring the use of PIPAC before or after surgery to prevent cancer from coming back.

Does insurance cover PIPAC?

PIPAC is mainly offered through clinical trials, which often are not covered by insurance. Instead, the cost of the procedure and related care is often covered by the study sponsor or the hospital running the trial.

However, some people may be able to get some coverage for parts of their care, such as lab tests, imaging or hospital stays, depending on their insurance and the trial setups. If you're interested in PIPAC, it's important to:

  • Ask the research team whether the trial sponsor or hospital covers costs.
  • Contact your insurance company to ask what is and isn't covered.
  • Request financial counseling from the hospital, if needed.

Coverage may change as more evidence becomes available and if PIPAC becomes an approved standard treatment in the future.

19/07/2025 انظر المزيد من التفاصيل الشاملة

اطلع كذلك على

  1. Acute lymphocytic leukemia
  2. Acute myelogenous leukemia
  3. Adenocarcinoma: How this type of cancer affects prognosis
  4. Adjuvant therapy for cancer
  5. Anal cancer
  6. Atypical cells: Are they cancer?
  7. B-cell lymphoma
  8. Beating Ovarian Cancer
  9. Biliary tract cancer: Should I get a second opinion?
  10. Biopsy procedures
  11. Bladder cancer
  12. Bladder Cancer
  13. What is bladder cancer? A Mayo Clinic expert explains
  14. Bladder cancer FAQs
  15. Bladder cancer treatment options
  16. Blood Cancers and Disorders
  17. Bone cancer
  18. Bone metastasis
  19. Brain tumor
  20. Brain Tumor
  21. What is a brain tumor? A Mayo Clinic expert explains
  22. Brain tumor FAQs
  23. Breast cancer
  24. Breast Cancer
  25. Breast cancer chemoprevention
  26. Breast Cancer Education Tool
  27. Common questions about breast cancer treatment
  28. Infographic: Breast Cancer Risk
  29. Breast cancer staging
  30. Breast cancer types
  31. Dr. Wallace Video
  32. Dr. Mark Truty (surgery, MN) better outcomes with chemo
  33. Burkitt lymphoma
  34. CA 125 test: A screening test for ovarian cancer?
  35. Cancer
  36. Cancer
  37. Cancer blood tests
  38. Myths about cancer causes
  39. Infographic: Cancer Clinical Trials Offer Many Benefits
  40. Cancer diagnosis: 11 tips for coping
  41. Cancer-related fatigue
  42. Cancer pain: Relief is possible
  43. Cancer risk: What the numbers mean
  44. Cancer surgery
  45. Cancer survival rate
  46. Cancer survivors: Care for your body after treatment
  47. Cancer survivors: Late effects of cancer treatment
  48. Cancer survivors: Managing your emotions after cancer treatment
  49. Cancer treatment myths
  50. Carcinoid syndrome
  51. CAR-T Cell Therapy
  52. Castleman disease
  53. Cervical cancer
  54. What is cervical cancer? A Mayo Clinic expert explains
  55. Cervical cancer FAQs
  56. Cervical cysts: Can they be cancerous?
  57. Cervical dysplasia: Is it cancer?
  58. Chemo targets
  59. Chemotherapy
  60. Chemotherapy and hair loss: What to expect during treatment
  61. Chemotherapy and sex: Is sexual activity OK during treatment?
  62. Chemotherapy nausea and vomiting: Prevention is best defense
  63. Chemotherapy side effects: A cause of heart disease?
  64. Cholangiocarcinoma (bile duct cancer)
  65. Chondrosarcoma
  66. Choroid plexus carcinoma
  67. Chronic lymphocytic leukemia
  68. Chronic myelogenous leukemia
  69. Collecting Pennies Through the Pain
  70. Colon cancer
  71. Colon Cancer Family Registry
  72. Colon cancer screening: At what age can you stop?
  73. Colon cancer screening
  74. Colorectal Cancer
  75. Curcumin: Can it slow cancer growth?
  76. Cutaneous T-cell lymphoma
  77. Cancer-related diarrhea
  78. Dragon Boats and Breast Cancer
  79. Early-onset colon cancer
  80. Eating during cancer treatment: Tips to make food tastier
  81. Embryonal tumors
  82. Endometrial cancer
  83. Ependymoma
  84. Esophageal cancer
  85. Esophageal Cancer
  86. Ewing sarcoma
  87. Fertility preservation
  88. Floor of the mouth cancer
  89. Follicular lymphoma
  90. Frequent sex: Does it protect against prostate cancer?
  91. Gallbladder cancer
  92. Gallbladder polyps: Can they be cancerous?
  93. Genetic Testing for Breast Cancer
  94. Genetic testing for breast cancer: Psychological and social impact
  95. GI Stents
  96. Glioblastoma
  97. Glowing Cancer Surgery
  98. Gynecologic Cancers
  99. Hairy cell leukemia
  100. Head and Neck Cancer
  101. Head and Neck Cancer Transoral Surgery
  102. Head and neck cancers
  103. Heart cancer: Is there such a thing?
  104. Hepatocellular carcinoma
  105. HER2-positive breast cancer: What is it?
  106. High-dose vitamin C: Can it kill cancer cells?
  107. Hilar cholangiocarcinoma
  108. Hodgkin lymphoma (Hodgkin disease)
  109. Hodgkin's vs. non-Hodgkin's lymphoma: What's the difference?
  110. Inflammatory breast cancer
  111. Invasive lobular carcinoma
  112. Is a clinical trial for biliary tract cancer right for me?
  113. Leukemia
  114. Liver cancer
  115. Liver Cancer
  116. What is liver cancer? An expert explains
  117. Liver cancer FAQs
  118. Living with biliary tract cancer
  119. Living with Brain Tumors
  120. Long Term Brain Cancer Survivor
  121. Low blood counts
  122. Lung cancer
  123. Infographic: Lung Cancer
  124. Lung Cancer
  125. Lung nodules: Can they be cancerous?
  126. Lymphoma
  127. What is lymphoma? An expert explains
  128. Lymphoma FAQs
  129. Magic mouthwash
  130. Male breast cancer
  131. Malignant peripheral nerve sheath tumors
  132. Mantle cell lymphoma
  133. Marginal zone lymphoma
  134. What is breast cancer? An expert explains
  135. Measles Virus as a Cancer Fighter
  136. Melanoma
  137. Melanoma and Skin Cancer
  138. Melanoma pictures to help identify skin cancer
  139. Merkel cell carcinoma
  140. Mesothelioma
  141. Metastatic (stage 4) prostate cancer
  142. Monoclonal antibody drugs
  143. Mort Crim and Cancer
  144. Mouth cancer
  145. What is mouth cancer? A Mayo Clinic expert explains
  146. Mouth cancer FAQs
  147. Mouth sores caused by cancer treatment: How to cope
  148. Multiple myeloma
  149. Infographic: Multiple Myeloma
  150. Myelofibrosis
  151. Myelofibrosis
  152. Myxofibrosarcoma
  153. Nasopharyngeal carcinoma
  154. Neuroblastoma
  155. Neuroendocrine tumors
  156. Neuroendocrine Tumors NETs
  157. New immunotherapy approved for metastatic bladder cancer
  158. No appetite? How to get nutrition during cancer treatment
  159. Non-Hodgkin lymphoma
  160. Oligodendroglioma
  161. Osteosarcoma
  162. Living with an ostomy
  163. Ovarian cancer
  164. Ovarian cancer: Still possible after hysterectomy?
  165. Paget's disease of the breast
  166. Palliative care for biliary tract cancer
  167. Pancreatic cancer
  168. Pancreatic Cancer
  169. What is pancreatic cancer? A Mayo Clinic expert explains
  170. Infographic: Pancreatic Cancer: Minimally Invasive Surgery
  171. Pancreatic Cancer Survivor
  172. Infographic: Pancreatic Cancers-Whipple
  173. Pancreatic neuroendocrine tumors
  174. Infographic: Pancreatic Neuroendocrine Tumors
  175. Pap test: Can it detect ovarian cancer?
  176. Paulas story A team approach to battling breast cancer
  177. Peripheral nerve tumors
  178. Peritoneal carcinomatosis
  179. Pheochromocytoma
  180. Pilocytic astrocytoma
  181. Pineoblastoma
  182. Pink Sisters
  183. Precision medicine: A new way to treat biliary cancers
  184. Prostate Cancer
  185. Prostate cancer
  186. Prostate cancer: Does PSA level affect prognosis?
  187. What is prostate cancer? A Mayo Clinic expert explains
  188. Prostate cancer prevention
  189. Prostate cancer FAQs
  190. Punk Guitarist Survives Brain Tumor
  191. Rectal cancer
  192. Recurrent breast cancer
  193. Retinoblastoma
  194. Robotic bladder surgery
  195. Salivary gland tumors
  196. Schwannomatosis
  197. Scientists propose a breast cancer drug for some bladder cancer patients
  198. Scrotal masses
  199. Self-Image During Cancer
  200. Skin cancer
  201. Infographic: Skin Cancer
  202. Skin Cancer Reconstruction
  203. Skull base tumors
  204. Small cell, large cell cancer: What this means
  205. Soft tissue sarcoma
  206. Spinal cord tumor
  207. Spinal tumor
  208. Stage 4 (metastatic) colon cancer
  209. Stomach cancer
  210. What is stomach cancer? A Mayo Clinic expert explains
  211. Stomach cancer FAQs
  212. Super Survivor Conquers Cancer
  213. Testicular cancer
  214. Testicular microlithiasis
  215. The Long Race Beating Cancer
  216. Throat cancer
  217. Thyroid cancer
  218. Thyroid Cancer
  219. What is thyroid cancer? A Mayo Clinic expert explains
  220. Thyroid cancer FAQs
  221. Treatment options for biliary tract cancer
  222. Tumor vs. cyst: What's the difference?
  223. Types of prostate cancer: Common and rare forms
  224. Vaginal cancer
  225. Vertebral tumor
  226. Melanoma — Early stage and advanced melanoma
  227. How cancer spreads
  228. PICC line placement
  229. Skin cancer — How skin cancer develops
  230. Vulvar cancer
  231. Weight Loss After Breast Cancer
  232. What is biliary tract cancer?
  233. When cancer returns: How to cope with cancer recurrence
  234. Wilms tumor
  235. Zollinger-Ellison syndrome