Perioperative safety and tolerability of pressurized intraperitoneal aerosolized chemotherapy (PIPAC) with concurrent systemic therapy in the same admission as a bidirectional chemotherapy: A retrospective comparative study.

OBJECTIVES

PIPAC has emerged as an important method to deliver intraperitoneal chemotherapy repeatedly and safely to achieve high locoregional concentrations to treat patients with peritoneal surface malignancies. Combination of systemic chemotherapy in the same admission of PIPAC, as a bidirectional chemotherapy seems appealing, as it may enhance the efficacy synergistically while improving the logistics and costs of treatment. In this study we aimed to establish the safety and tolerability of this bidirectional approach.

METHODS

This is a retrospective study of a prospectively maintained database. All patients who underwent PIPAC from Jan 2023 to May 2025 were included in this study. PIPAC cycles were categorised as those in which patients received chemotherapy in the same admission i.e within 3 days (CONC group) and those who received chemotherapy not in the same admission (non-CONC Group). Morbidity and Mortality of both groups were analysed.

RESULTS

A total of 111 patients were included in this study who underwent 202 cycles of PIPAC. There were 159 cycles in the CONC group and 43 cycles in the non-CONC group. Disease and treatment characteristics were compared. The CONC group had a significantly higher PCI with mean 21.6 vs 20.4, p = 0.05. There was no 30-day mortality in both groups. There was no significant difference in overall morbidity in both groups (CONC group 7.5% vs non-CONC group 6.9%), p = 0.899. Likewise, exploratory multivariate analysis, limited by sparse events, did not show a significant association of concurrent bidirectional chemotherapy with morbidity (odds ratio 1.16; 95% CI 0.28-4.77; p = 0.835).

CONCLUSION

Our experience demonstrates that PIPAC and intravenous chemotherapy may not require a separating interval of one or two weeks, and it can be feasibly and safely administered within a single hospital admission, based on short term outcomes. This multimodal oncological care approach may streamline care, improve compliance and logistics, and enhance patient-centricity.