PIPAC Surgery

PIPAC stands for Pressurized Intraperitoneal Aerosol Chemotherapy. It is performed under general anaesthesia through two laparoscopic ports (5–12 mm). A specialised micro-pump injector aerosolizes the chemotherapy solution at a controlled pressure of 12 mmHg. The aerosol dwells in the sealed abdominal cavity for approximately 30 minutes, penetrating peritoneal tumour deposits far more effectively than liquid chemotherapy.

The procedure takes approximately 90 minutes in total, including diagnostic laparoscopy, peritoneal cancer index (PCI) scoring, tissue biopsies, and the PIPAC delivery itself. The chemotherapy aerosol is then evacuated through a closed filtration system before the ports are removed.

Both PIPAC and HIPEC deliver chemotherapy directly to the abdominal cavity, but they serve different clinical scenarios and are not interchangeable:

• HIPEC is performed during major open cytoreductive surgery. Heated liquid chemotherapy is circulated for 60–90 minutes. It requires a large incision, carries significant surgical morbidity, and is used with curative intent in selected patients.
• PIPAC is performed laparoscopically through two small ports. Aerosolized chemotherapy is applied under pressure for approximately 30 minutes. It can be repeated every 6–8 weeks. Lower morbidity, shorter hospital stay (typically 2–3 days), and faster recovery.

PIPAC is not a replacement for HIPEC. It is particularly valuable for patients who are not candidates for radical cytoreductive surgery, or as a bridge therapy to convert previously unresectable disease into operable disease suitable for cytoreduction and HIPEC.

PIPAC may be appropriate in the following clinical situations:

• Recurrent ovarian cancer with peritoneal-only disease that is not amenable to further cytoreductive surgery
• Platinum-resistant ovarian cancer — where systemic chemotherapy options are limited or poorly tolerated
• Primary peritoneal cancer with peritoneal carcinomatosis
• Neoadjuvant conversion — shrinking peritoneal disease to allow subsequent cytoreductive surgery combined with HIPEC
• Palliation — controlling malignant ascites and peritoneal disease burden when curative surgery is not feasible
• Peritoneal metastases from gastrointestinal cancers — in selected patients managed within a multidisciplinary framework

Each PIPAC course is planned within a multidisciplinary tumour board, ensuring that the treatment strategy — whether conversion, palliation, or combination with systemic therapy — is individualised and evidence-based.

Advanced ovarian cancer frequently spreads across the peritoneum. While HIPEC with cytoreductive surgery is the established approach for peritoneal disease amenable to complete resection, many patients present with unresectable disease, recurrence after prior surgery, or platinum-resistant disease where standard options are limited.

PIPAC addresses this treatment gap. Published data from European centres demonstrates objective tumour regression in 60–70% of treated patients, reduction in ascites, and improvement in quality of life — even in heavily pre-treated populations. PIPAC can be repeated every 6–8 weeks, allowing serial assessment of disease response through peritoneal biopsies at each session.

Dr. Nishtha Tripathi Patel offers PIPAC for ovarian cancer at her practice in Ahmedabad, integrated with the broader oncology services at Sterling Hospitals, KD Hospital, and Welcare Speciality Hospital.

1. Diagnostic laparoscopy — two ports are inserted. The surgeon inspects the entire peritoneal cavity and documents the distribution and volume of disease using the Peritoneal Cancer Index (PCI) scoring system.
2. Tissue biopsies — multiple peritoneal biopsies are taken for histological assessment and to track treatment response over serial PIPAC sessions.
3. PIPAC delivery — the micro-pump injector aerosolizes the chemotherapy (typically cisplatin 10.5 mg/m² and doxorubicin 2.1 mg/m² for ovarian cancer) at 12 mmHg pressure for 30 minutes.
4. Evacuation — the chemotherapy aerosol is evacuated through a closed-circuit filtration system, ensuring operating room safety.
5. Closure — ports are removed and the small incisions are closed.

The entire procedure takes approximately 90 minutes. PIPAC sessions are typically repeated every 6–8 weeks for 3–6 cycles, depending on treatment response.

Because PIPAC is laparoscopic, recovery is substantially faster than after major open surgery:

• Hospital stay: typically 2–3 days
• Return to normal activities: 7–10 days
• Abdominal discomfort: mild, at port sites, resolves within a few days
• Nausea: occurs in approximately 30% of patients, managed with standard anti-emetics
• Systemic side effects: significantly lower than IV chemotherapy because drug exposure is predominantly local — hair loss and severe bone marrow suppression are uncommon

Serious complications are rare but may include bowel injury, port-site infection, or allergic reaction to the chemotherapy agent. All patients are monitored closely during and after the procedure.

PIPAC has been available in major European cancer centres for several years but remains limited in India. Dr. Nishtha Tripathi Patel is among a small number of gynaecological oncologists in western India offering PIPAC as part of a structured peritoneal surface malignancy treatment programme.

Patients from across Gujarat — including Surat, Vadodara, Gandhinagar, Rajkot, and Bhavnagar — as well as from Rajasthan, Madhya Pradesh, and Maharashtra can access PIPAC in Ahmedabad without travelling to Mumbai or Delhi.

Consultations are available at Sterling Hospitals (Sindhubhavan), KD Hospital, and Welcare Speciality Hospital in Ahmedabad. No GP referral is required — patients can contact the practice directly.

PIPAC is not a standalone treatment — it is one component of a comprehensive peritoneal surface malignancy management strategy. The decision to offer PIPAC, the choice of chemotherapy agents, the number of cycles, and the assessment of conversion to surgical candidacy all require specialist expertise and multidisciplinary input.

At Dr. Nishtha Tripathi Patel’s practice, every PIPAC case is discussed in a multidisciplinary tumour board meeting with medical oncologists, radiation oncologists, and pathologists before treatment is initiated — ensuring that PIPAC fits within the optimal overall treatment pathway for each individual patient.