PIPAC for Gastrointestinal Malignancies
The peritoneum is a common site of metastases for gastrointestinal tumors that predicts a poor outcome. In addition to decreased survival, peritoneal metastases (PMs) can significantly impact quality of life from the resulting ascites and bowel obstructions. The peritoneum has been a target for regi...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-10-01
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| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/12/21/6799 |
| _version_ | 1797631735168499712 |
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| author | Sara K. Daniel Beatrice J. Sun Byrne Lee |
| author_facet | Sara K. Daniel Beatrice J. Sun Byrne Lee |
| author_sort | Sara K. Daniel |
| collection | DOAJ |
| description | The peritoneum is a common site of metastases for gastrointestinal tumors that predicts a poor outcome. In addition to decreased survival, peritoneal metastases (PMs) can significantly impact quality of life from the resulting ascites and bowel obstructions. The peritoneum has been a target for regional therapies due to the unique properties of the blood–peritoneum barrier. Cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) have become accepted treatments for limited-volume peritoneal disease in appendiceal, ovarian, and colorectal malignancies, but there are limitations. Pressurized intraperitoneal aerosolized chemotherapy (PIPAC) improves drug distribution and tissue penetration, allowing for a minimally invasive application for patients who are not CRS/HIPEC candidates based on high disease burden. PIPAC is an emerging treatment that may convert the patient to resectable disease, and may increase survival without major morbidity, as indicated by many small studies. In this review, we discuss the rationale and benefits of PIPAC, as well as sentinel papers describing its application for gastric, colorectal, appendiceal, and pancreatobiliary PMs. While no PIPAC device has yet met FDA approval, we discuss next steps needed to incorporate PIPAC into neoadjuvant/adjuvant treatment paradigms, as well as palliative settings. Data on active clinical trials using PIPAC are provided. |
| first_indexed | 2024-03-11T11:27:33Z |
| format | Article |
| id | doaj.art-9b248729c6844e5f90bbcf8f965c7abf |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T11:27:33Z |
| publishDate | 2023-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-9b248729c6844e5f90bbcf8f965c7abf2023-11-10T15:06:30ZengMDPI AGJournal of Clinical Medicine2077-03832023-10-011221679910.3390/jcm12216799PIPAC for Gastrointestinal MalignanciesSara K. Daniel0Beatrice J. Sun1Byrne Lee2Department of Surgery, Stanford University, Stanford, CA 94305, USADepartment of Surgery, Stanford University, Stanford, CA 94305, USADepartment of Surgery, Stanford University, Stanford, CA 94305, USAThe peritoneum is a common site of metastases for gastrointestinal tumors that predicts a poor outcome. In addition to decreased survival, peritoneal metastases (PMs) can significantly impact quality of life from the resulting ascites and bowel obstructions. The peritoneum has been a target for regional therapies due to the unique properties of the blood–peritoneum barrier. Cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) have become accepted treatments for limited-volume peritoneal disease in appendiceal, ovarian, and colorectal malignancies, but there are limitations. Pressurized intraperitoneal aerosolized chemotherapy (PIPAC) improves drug distribution and tissue penetration, allowing for a minimally invasive application for patients who are not CRS/HIPEC candidates based on high disease burden. PIPAC is an emerging treatment that may convert the patient to resectable disease, and may increase survival without major morbidity, as indicated by many small studies. In this review, we discuss the rationale and benefits of PIPAC, as well as sentinel papers describing its application for gastric, colorectal, appendiceal, and pancreatobiliary PMs. While no PIPAC device has yet met FDA approval, we discuss next steps needed to incorporate PIPAC into neoadjuvant/adjuvant treatment paradigms, as well as palliative settings. Data on active clinical trials using PIPAC are provided.https://www.mdpi.com/2077-0383/12/21/6799peritoneal metastasesintraperitoneal chemotherapyPIPAC |
| spellingShingle | Sara K. Daniel Beatrice J. Sun Byrne Lee PIPAC for Gastrointestinal Malignancies Journal of Clinical Medicine peritoneal metastases intraperitoneal chemotherapy PIPAC |
| title | PIPAC for Gastrointestinal Malignancies |
| title_full | PIPAC for Gastrointestinal Malignancies |
| title_fullStr | PIPAC for Gastrointestinal Malignancies |
| title_full_unstemmed | PIPAC for Gastrointestinal Malignancies |
| title_short | PIPAC for Gastrointestinal Malignancies |
| title_sort | pipac for gastrointestinal malignancies |
| topic | peritoneal metastases intraperitoneal chemotherapy PIPAC |
| url | https://www.mdpi.com/2077-0383/12/21/6799 |
| work_keys_str_mv | AT sarakdaniel pipacforgastrointestinalmalignancies AT beatricejsun pipacforgastrointestinalmalignancies AT byrnelee pipacforgastrointestinalmalignancies |