PIPAC – Innovative, Direct Delivery of Chemotherapy for Peritoneal Metastasis

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.

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.

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

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

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.