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PIPAC – Innovative, Direct Delivery of Chemotherapy for Peritoneal Metastasis

PIPAC – Innovative, Direct Delivery of Chemotherapy for Peritoneal Metastasis

PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy) is a groundbreaking method of delivering chemotherapy.

It administers a highly concentrated, aerosolized treatment directly into the abdominal cavity. Specially trained and experienced physicians in the Department of Surgical Oncology (Surgery C) at Sheba Medical Center perform PIPAC for suitable candidates.
When PIPAC is used in combination with systemic chemotherapy, it enables peritoneal (abdominal) metastasis to be controlled with fewer adverse events. This leading-edge therapy has been shown to be particularly effective for palliation and for down-staging cancer patients who have not reached end stage disease.

PIPAC page

How does PIPAC chemotherapy work?

PIPAC is a minimally invasive laparoscopic surgery performed under general anesthesia. The revolutionary technology uses a video camera and a specialized device called Capnopen. Capnopen, a nebulizer tool, originated as a fuel injection technology in the automotive world, and it pressurizes the chemotherapy agents – turning them into aerosol.

Prior to administering PIPAC, biopsies of the abdominal cavity are performed and the peritoneal cancer index (PCI) is evaluated by video. When used together, these assessment procedures provide both an objective and subjective analysis of the patient’s response to chemotherapy.

The Capnopen is connected to an injector and inserted into the abdomen through a trocar (a surgical access port). Then, the therapeutic aerosolized chemotherapy drug is given; the particular cytotoxic agents are determined based on the primary disease. The drug delivery is done for 30 minutes before the aerosol is removed via a closed smoke-evacuation system. From start to finish, PIPAC takes about an hour.

Generally, patients remain hospitalized for one night after PIPAC, and the procedure is well tolerated. Repeat applications are typically done every six weeks, and on average, PIPAC is administered to each patient three times before their disease is reassessed.

There are several benefits to administering chemo as a spray, namely:

  • A smaller dosage is required, since the combination of the pressurized delivery and tiny aerosol particles penetrates the tumor tissue more deeply.
  • The aerosol dissolves more uniformly within the abdominal cavity, thereby encapsulating the tumor and preventing it from spreading.

What conditions can be treated with PIPAC?

PIPAC can be a suitable treatment for patients with the following types of cancer:

  • Abdominal metastasis from malignant tumors in the stomach, colon, pancreas, liver, and appendix
  • Mesothelioma
  • Women with ovarian cancer and metastasis into the abdominal cavity

The main goal of PIPAC is to prolong survival and improve quality of life for patients with these conditions.

Who is a candidate for PIPAC?

PIPAC is intended for cancer patients with peritoneal metastasis who have the following conditions:

  • Severe side effects caused by systemic chemotherapy
  • No longer responsive to systemic oncologic treatment
  • Large amount of persistent ascites (accumulation of protein-containing fluid in the abdomen)
  • Non-eligible for CRS (cytoreductive surgery) due to extensive disease load
  • Non-eligible for HIPEC (hyperthermic intraperitoneal chemotherapy) due to extensive disease load

PIPAC cannot be administered to patients who:

  • Underwent multiple abdominal surgeries in the past
  • Have metastasis other than the abdomen
  • Have a poor overall performance status
  • Have biliary or small bowel obstructions

What are the possible side effects from PIPAC Chemotherapy?

Quality of life (QoL) for patients with peritoneal metastasis who received PIPAC treatment has been studied, and the most striking result is that QoL stabilized. In general, gastrointestinal symptoms did not worsen, and any pain that was experienced was transitory. Patients did not generally report the common side effects of systemic chemotherapy (such as extreme nausea, vomiting, diarrhea, mucositis, hair loss).

Possible side effects may include:

  • Mild abdominal pain
  • Mild feelings of discomfort
  • Slight nausea

Why choose Sheba for PIPAC in Israel?

PIPAC is delivered at the Department of Surgical Oncology (Surgery C) at Sheba, which features a team of highly qualified specialists. Our physicians have extensive experience in treating peritoneal cancer, and we are responsible for bringing the cutting-edge PIPAC treatment to Israel. Prof. Aviram Nissan, Director of our Department of General and Oncology Surgery, and Dr. Almog Ben Yaakov, expert in oncology surgery, learned how to implement this treatment in Paris with the world-leading doctors who invented and developed the PIPAC technology.

Sheba, the most comprehensive hospital in the region, is steadfastly committed to treating patients with the most progressive, advanced therapies. At this point, our doctors have performed PIPAC successfully for many patients who qualified for the progressive procedure. As a result, the tumors stopped progressing, and the patients experienced a substantial improvement in their quality of life.

PIPAC at Sheba is affordable. We provide top value at a cost that is lower than the prices for cancer treatment at other leading hospitals. As a government institution, our fees are transparent and highly affordable – with no compromises on the quality of your medical care.

Navigating your way through medical treatments can be confusing. That’s why we assign a personal coordinator from our International Medical Tourism Division to every patient. Your coordinator provides full assistance – from helping with travel arrangements to providing explanations in your language. You will benefit from clear communication and an efficient healthcare experience.

Meet Our Doctors

Aviram Nissan
Prof. Aviram Nissan
Head of Department of Surgery C
Prof. Aviram Nissan is a world-recognized physician in oncological surgery, with particular expertise in complex tumors of the digestive system. He is a leading specialist in HIPEC treatment of abdominal metastasis, and he is one of the first doctors to learn PIPAC and bring it to Israel. In addition, Prof. Nissan has extensive experience in the surgical treatment of colorectal cancer, stomach cancer, and sarcomas (soft tissue tumors). As the Director of the Laboratory of Surgical Oncology at Sheba, he is actively researching tumors of the digestive tract and peritoneal cavities. Prof. Nissan has received numerous prestigious awards, and he publishes and lectures widely around the world. Prof. Nissan was born in the US and received his medical degree from the Hadassah School of Medicine at the Hebrew University, Jerusalem. He completed surgical residencies in several surgical departments worldwide, including Hadassah-Mt. Scopus, Mount Sinai Medical Center in New York, Memorial Sloan Kettering Cancer Center, and Ludwig Institute for Cancer Research in New York. Since 2015, he has been Head of the Department of General and Oncology Surgery at Sheba.
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Almog Ben Yaacov
Dr. Almog Ben-Yaakov
Dr. Almog Ben-Yaakov specializes in CRS and HIPEC procedures, gastric cancer, sarcomas, and complex colorectal malignancies. By 2018, he had performed over 200 HIPEC procedures under the guidance of Prof. Nissan, a world-renowned specialist in CRS and HIPEC. In 2006, Dr. Ben-Yaakov received his medical degree with honors from Semmelweis University Medical School, a research-led institution in Budapest, Hungary. He then completed many training programs to master new technologies, including an ESSO course on HIPEC, liver ablative surgery using microwave ablation, and NanoKnife. In 2019, he is participating in advanced training in oncological surgery at Memorial Sloan Kettering Hospital in New York.
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Sheba Medical Center provides innovative, personalized medical care to patients from around the world. We are the largest, most comprehensive hospital in the Middle East and dedicated to providing advanced and compassionate medicine for everyone.

We welcome all cases, including the rarest and the most challenging. Our medical teams collaborate to provide the best possible health outcomes. From your initial inquiry through the long-term follow-up care, we are here for you.

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