Feasibility, efficacy and safety of pressurized intraperitoneal aerosol chemotherapy (PIPAC) for hepatobiliary and pancreatic cancers with peritoneal metastases: A systematic review.

BACKGROUND

Hepato-pancreato-biliary (HPB) cancers frequently develop peritoneal metastases, signalling a poor prognosis and severely limiting the efficacy of systemic treatments. This review evaluates the feasibility, efficacy, and safety of Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) for these malignancies.

METHODS

We conducted a systematic review in accordance with the PRISMA guidelines. A comprehensive, structured search strategy was applied to PubMed, Scopus, and Web of Science to identify eligible non-interventional studies involving adult patients with HPB cancers and peritoneal metastases undergoing PIPAC.

RESULTS

Ten studies encompassing 332 patients were included. PIPAC was feasible, with non-access rates ranging from 0% to 11.8%. Patients completed a mean of 1.3-1.8 cycles for hepatobiliary and 2.1-3 cycles for pancreatic cancers. Median overall survival ranged from 85 days to 15.1 months for hepatobiliary malignancies, and 8.5 to 12.7 months for pancreatic cancers. The procedure demonstrated a high safety profile, with no severe postoperative systemic toxicities (Common Terminology Criteria for Adverse Events grade ≥3) reported.

CONCLUSION

PIPAC appears to be a safe, feasible and potentially efficacious intervention for HPB peritoneal metastases. However, current evidence remains heterogeneous, necessitating standardised, prospective trials to clearly define its clinical role.