Frequently Asked Questions

PIPAC stands for Pressurized IntraPeritoneal Aerosol Chemotherapy: roughly, chemotherapy given under pressure as an aerosol into the abdominal cavity. During a short laparoscopy (keyhole surgery), a chemotherapy drug is delivered under pressure as a fine spray directly into the abdomen. The fine mist spreads evenly over the peritoneum and can penetrate tumour tissue better than chemotherapy that is filled into the abdomen as a liquid.

The procedure has been in clinical use since 2011; the first scientific evidence of its efficacy came from Solass and colleagues (Annals of Surgical Oncology, 2013).

Each part of the name describes a feature of the treatment:

• Pressurized: the drug is introduced under positive pressure so that it spreads evenly and penetrates more deeply.
• IntraPeritoneal (into the abdominal cavity): the chemotherapy acts directly where the tumour cells are.
• Aerosol: the drug is turned into a fine spray instead of being given as a liquid.
• Chemotherapy: it is a drug that inhibits cell growth.

In conventional chemotherapy, the drug is given by infusion into the bloodstream and spreads throughout the whole body. It reaches the peritoneum only poorly, while the entire body is put under strain.

With PIPAC, the drug goes straight to the affected peritoneum. This allows a high drug concentration at the tumour, while the strain on the rest of the body is considerably lower. Studies of tissue distribution show that the aerosolised drug reaches the peritoneum and penetrates the tissue (Khosrawipour et al., Annals of Surgical Oncology, 2015).

As a rule, no. PIPAC is usually an addition and can be combined with systemic chemotherapy or other treatments. The overall treatment is planned around your situation. Your doctors will talk through with you what makes sense in your case.

PIPAC 2.0 is a further development of the procedure in which Prof. Dr. Jürgen Zieren plays a leading role. Changes include adjusted dosing, an improved nozzle for more even distribution, and finer control of pressure and temperature. Initial clinical data on higher-dose variants (HP/HD-PIPAC) were published by Ramos Arias and colleagues (Annals of Surgical Oncology, 2023). You will find detailed information on our Science & Research page.

The treatment is carried out under general anaesthesia as part of a laparoscopy (keyhole surgery of the abdomen). Thin instruments are inserted into the abdomen through two small incisions. The chemotherapy aerosol is then sprayed under pressure through a special nozzle for a few minutes and is left to act for a short time. The aerosol is then removed completely through a closed system, and the small incisions are closed.

The procedure itself usually takes about 30 to 60 minutes. In addition, there is preparation, anaesthesia and monitoring in the recovery room. PIPAC is considered a minimally invasive and gentle procedure.

PIPAC is usually given in several cycles, typically about six weeks apart. Many treatment plans include three or more sessions so that the effect can be assessed and the course of the disease monitored. The exact number depends on how you respond and how you are feeling, and is decided individually.

Because PIPAC is minimally invasive, the hospital stay is usually short, often only a few days. The exact length depends on your general condition and on how things go, and is decided by the treating team.

Yes. PIPAC can be combined with systemic chemotherapy and, depending on the situation, with surgery. The international expert consensus (Tozzi et al., European Journal of Surgical Oncology, 2024) describes how patients are selected for PIPAC and how therapies can be sensibly combined.

PIPAC may be an option for tumours that have spread to the peritoneum (peritoneal carcinomatosis). These include in particular:

• Stomach cancer with peritoneal involvement (Nadiradze et al., Journal of Gastrointestinal Surgery, 2015)
• Bowel cancer (colorectal peritoneal metastases; Tabchouri et al., Annals of Surgical Oncology, 2021)
• Ovarian cancer (Tempfer et al., Gynecologic Oncology, 2015)
• Pancreatic cancer and other tumours with peritoneal involvement

In most cases, PIPAC is not a curative but a tumour-controlling treatment. The aim is to slow tumour growth, relieve symptoms and maintain or improve quality of life. In some patients, the treatment can reduce the tumour burden. What is realistic in your individual case is something we clarify in a personal consultation.

Studies show that PIPAC can lead to a response of the tumour on the peritoneum in some of the patients treated. An early phase 2 study in recurrent ovarian cancer observed a response in several patients (Tempfer et al., Gynecologic Oncology, 2015). A systematic review summarises the clinical and experimental evidence (Tempfer et al., Archives of Gynecology and Obstetrics, 2018). How well it works varies from person to person, and PIPAC is always one part of the wider treatment.

Preserving quality of life is one of the main aims of PIPAC. A study in patients with advanced peritoneal metastases showed that quality of life remained largely stable during treatment (Odendahl et al., European Journal of Surgical Oncology, 2015). The procedure itself is minimally invasive.

Because only a low dose of the drug is used and it acts mainly locally, serious side effects are less common than with systemic chemotherapy. The main possible effects are abdominal pain after the procedure, nausea or temporary tiredness. As with any operation, there are also the general risks of surgery and anaesthesia. Your treatment team will go through all of this with you beforehand.

PIPAC is considered well tolerated and safe when it is performed in experienced centres. Experience from a series of more than 1,200 procedures describes how the procedure can be carried out safely from a technical point of view (Giger-Pabst & Tempfer, Journal of Gastrointestinal Surgery, 2018). Studies of kidney and liver tolerability found no relevant organ damage caused by the treatment (Blanco et al., Annals of Surgical Oncology, 2013).

No. This question has been specifically studied. While the aerosol is acting, the operating theatre is closed and nobody is in the room; the system is completely evacuated. Occupational safety studies confirm that, when the procedure is performed correctly, there is no relevant exposure for staff (Solass et al., Annals of Surgical Oncology, 2013; Oyais et al., Zentralblatt für Chirurgie, 2016).

PIPAC is intended for people with tumour involvement of the peritoneum in whom surgery to remove it completely is not (or no longer) possible, or who may benefit from an additional local treatment. Whether PIPAC is suitable for you depends on the type of tumour, the extent of the disease and your general condition. An international expert consensus describes criteria for selecting suitable patients (Tozzi et al., European Journal of Surgical Oncology, 2024).

In certain situations PIPAC is not appropriate, for example with extensive adhesions in the abdomen, a bowel obstruction or a severely reduced general condition that does not allow anaesthesia. That is why suitability is always assessed case by case, in a personal consultation and with a careful examination.

There is no fixed age limit. What matters is your general condition, not your age in years. PIPAC has, for example, also been used successfully in a patient over 80 years of age (Giger-Pabst et al., Anticancer Research, 2015). Whether treatment is an option for you is something we clarify individually.

Peritoneal carcinomatosis is the spread of cancer cells on the peritoneum, the thin membrane that lines the abdominal cavity and covers the internal organs. It usually develops when cancer cells break away from other organs such as the stomach, bowel, ovary or pancreas and settle in the abdominal cavity. You can find out more on our Information & Consultation page.

In the early stages there are often no symptoms or only non-specific ones. As the disease progresses, the following may occur: unexplained abdominal pain or a feeling of pressure, bloating and a feeling of fullness, nausea and digestive problems, unintended weight loss, an increase in abdominal girth due to fluid in the abdomen (ascites) and general weakness. As these symptoms can have many causes, it is important to have them checked by a doctor.

Ascites is a build-up of fluid in the abdominal cavity that often occurs with peritoneal cancer and leads to a growing abdominal girth and a feeling of pressure. In some cases, a local treatment such as PIPAC can help to reduce the formation of abdominal fluid and so relieve symptoms. Whether this can be expected in your case will be discussed with you by the treating doctors.

Diagnosis uses imaging (ultrasound, CT, MRI), blood tests and, above all, laparoscopy (keyhole examination of the abdomen). During laparoscopy, the peritoneum can be viewed directly and a tissue sample taken. Examining that sample under the microscope confirms the diagnosis, which is why laparoscopy is considered the gold standard.

Whether the costs are covered depends on the individual case, the disease and the specific treatment plan. In many cases the costs are covered; in others, it needs to be clarified with the health insurer beforehand. We can help you work out the necessary steps. Just contact us.

The easiest way is through our contact form or by email. We will advise you personally and help you find a suitable hospital and arrange an appointment. Relatives can contact us too. You will find details under Information & Consultation.

Of course. With a cancer diagnosis, a second opinion makes sense, and it is your right. We will review your medical reports and answer your questions, wherever you have been treated so far.

Yes. The German PIPAC Center is also contacted by international patients. Get in touch, and we will work through the organisational questions and the possible next steps with you.