HIPEC and PIPAC both deliver chemotherapy directly into the abdominal cavity, but they are not interchangeable. The decision between them is one of the more nuanced choices in peritoneal disease management. Here is the framework.
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Pipac vs hipec — Quick comparison
- HIPEC: one-time procedure, performed during major open cytoreductive surgery, heated chemo, 60-90 minutes
- PIPAC: repeat-cycle procedure, performed laparoscopically (less invasive), aerosolised chemo under pressure, brief (30 min), can be repeated every 6 weeks
When HIPEC is the right choice
- Patient is fit for major surgery
- Disease can be completely resected (CC-0 or CC-1)
- Primary cytoreductive surgery or interval surgery after neoadjuvant chemo
- Stage 3 ovarian cancer at interval cytoreduction (strongest evidence)
- Pseudomyxoma peritonei
- Selected colorectal peritoneal carcinomatosis
When PIPAC is the right choice
- Disease is unresectable
- Recurrent peritoneal disease after prior treatment
- Patient too unwell for major open surgery
- Need for repeated treatment cycles
- Bridge to systemic chemotherapy in selected cases
- Refractory ascites palliation
When both may be used
Some patients receive HIPEC at primary surgery, then PIPAC cycles later for recurrent disease. The two are sequential, not competitive. Dr. Nishtha’s published research on bi-directional chemotherapy (combining intraperitoneal PIPAC with systemic chemo) explores this combination — see the academic paper.
Decision framework
The decision hinges on three questions:
- Is the disease completely resectable? (Yes → HIPEC. No → PIPAC.)
- Is this primary or recurrent? (Primary → HIPEC consideration. Recurrent → PIPAC consideration.)
- What is patient fitness? (Fit → HIPEC. Less fit → PIPAC may be safer.)
Multi-disciplinary review is essential because individual cases sometimes fit both or neither — and ongoing systemic therapy choices interact with the local intraperitoneal approach.
FAQs
Can PIPAC cure cancer?
PIPAC is rarely curative — it is mostly used for control and palliation of peritoneal disease. HIPEC, combined with complete cytoreduction, can be curative for selected cancers.
How many PIPAC cycles are needed?
Typically 3 cycles, 6 weeks apart. Response is assessed between cycles by laparoscopic biopsy.
Can PIPAC be combined with systemic chemo?
Yes — bi-directional chemotherapy (PIPAC + IV chemo) is an active area of research. Patient selection matters.
Is PIPAC available in India?
Yes, at a small number of high-volume centres. The procedure requires specialised equipment and trained team. Dr. Nishtha performs PIPAC at Sterling Hospitals, Ahmedabad.
Which is cheaper?
PIPAC per cycle (Rs 1.5–3 lakh) is cheaper than HIPEC (Rs 5–12 lakh) per procedure. But 3 cycles of PIPAC may approach single HIPEC cost. See PIPAC cost page.
Reviewed by Dr. Nishtha Tripathi Patel, MBBS, DGO, DNB, Fellowship Gynaecological Oncology, ESGO-certified. To book: WhatsApp +91 76988 00333.