The short answer: HIPEC and PIPAC both put chemotherapy directly inside the tummy (the abdominal cavity), but they are used in different situations and are not interchangeable. HIPEC (heated chemotherapy, sometimes called garam chemo) is given once, during a long open operation that first removes all visible cancer. It is considered only when all visible tumour can be removed and the patient is fit for major surgery. PIPAC is a short keyhole (laparoscopic) procedure that sprays chemotherapy as a fine mist and can be repeated. It is mainly used when cancer on the lining of the tummy cannot be fully removed, usually to control the disease and ease symptoms rather than to cure it. Neither is right for everyone, and many women need neither. Your team decides after looking at your scans, reports and overall fitness. If HIPEC has been suggested, read about HIPEC eligibility and treatment and preparation and recovery around HIPEC.
People also search for this in Hindi as “HIPEC kya hai” or “PIPAC aur HIPEC me kya fark hai” (HIPEC और PIPAC में क्या फ़र्क है).
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Quick comparison
- HIPEC: given once, at the end of a major open operation to remove the cancer (cytoreductive surgery). The heated chemotherapy wash itself takes about 60–90 minutes, but the whole operation usually takes 8–14 hours, followed by about 10–14 days in hospital, including 3–5 days in intensive care (ICU).
- PIPAC: a keyhole (laparoscopic) procedure through two small cuts. The chemotherapy mist is sprayed under pressure and left inside for about 30 minutes; the whole procedure takes about 1.5 hours. It is usually repeated about every 6 weeks, and recovery is much quicker than after HIPEC.
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
Even when these apply, HIPEC is not right for everyone and is not a guaranteed cure. It is one part of the wider plan for ovarian cancer diagnosis and treatment, which also includes chemotherapy and, for some women, maintenance tablets.
When PIPAC is the right choice
- The cancer on the tummy lining cannot be fully removed by surgery (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
- Fluid in the tummy that keeps coming back (refractory ascites), to ease symptoms
PIPAC is a newer treatment and the evidence is still developing. Small studies show it can shrink deposits on the tummy lining and reduce fluid build-up in some patients, and a recent Indian randomised trial reported better tumour response than chemotherapy through a vein in women with platinum-resistant ovarian cancer (an early, interim result). It is not yet proven that PIPAC helps people live longer, so it is offered only to selected patients, often alongside chemotherapy through a vein. Read more about PIPAC surgery.
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:
- Can all visible cancer be removed by surgery? (Yes → HIPEC may be considered. No → PIPAC may be considered.)
- Is this the first treatment, or has the cancer come back (recurrence)? (At first treatment, HIPEC may be considered. When cancer comes back, a second operation is still possible for some women; PIPAC is considered mainly when it is not.)
- How fit is the patient? (Fit for a long operation → HIPEC may be possible. 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?
Often about 3 sessions, about 6 weeks apart, though some people have fewer or more. At each session the surgeon looks inside the tummy and takes small samples (biopsies) to check how the cancer is responding.
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 and KD Hospital, Ahmedabad.
Which is cheaper?
As a rough guide, one PIPAC session (about Rs 1.5–3 lakh) costs less than HIPEC with cancer-removal surgery (about Rs 5–12 lakh), but 3 PIPAC sessions can add up to a similar amount. These are indicative ranges, not a quote; the written estimate comes from the hospital where the procedure is done (Sterling Hospitals or KD Hospital). See the PIPAC cost page and the HIPEC cost page.
Reviewed by Dr. Nishtha Tripathi Patel, MBBS, DGO, DNB, Fellowship Gynaecological Oncology, ESGO-certified. To book: WhatsApp +91 76988 00333.