The role of intra-abdominal pressurized aerosol chemotherapy (pipac) in the treatment of gastric cancer peritoneal carcinomatosis: a systematic review

Pepenin M., Кондрацький Ю.М., Horodetskyi A., Dobrzhanskyi O.

Summary. Introduction. Patients diagnosed with gastric cancer peritoneal carcinomatosis have an overall survival of 3–6 months. Current treatment algorithms recommend systemic therapy in combination with immunotherapy or targeted therapy; however, this approach proves to be effective in only 14–25% of cases. For patients with gastric cancer peritoneal carcinomatosis, intraperitoneal chemotherapy methods such as HIPEC and NIPEC have been developed and implemented. However, these methods are associated with certain limiting factors, such as the uneven distribution of the active substance throughout the abdominal cavity and its complicated exposure in hard-to-reach places. Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) was developed to eliminate these limitations, where the pressure of the capnoperitoneum and the physical properties of aerosol chemotherapy lead to a more uniform distribution of the active substance in the abdominal cavity and better penetration of tumor tissue. Objective. The study aims to analyze the effectiveness of Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) as an innovative method for treating gastric cancer peritoneal carcinomatosis. The study subject is a group of patients with peritoneal carcinomatosis of gastric cancer who received treatment using the PIPAC procedure. The research methods included a systematic review of medical databases MEDLINE, Cochrane, and Embase to collect and analyze data on the effectiveness and safety of PIPAC. Main Findings. The study’s main findings indicated that PIPAC provides an increase in overall survival, reduction in ascites volume, and improvement in the patients quality of life. The method demonstrates potential for increasing overall survival and reducing the frequency of complications compared to other methods of intraperitoneal chemotherapy. Complete pathological response, although a rare occurrence, indicates the potential of PIPAC as an effective treatment for peritoneal carcinomatosis. Conclusions. PIPAC is an effective and safe treatment method for patients with peritoneal carcinomatosis of gastric cancer. Further research on PIPAC is recommended to determine the optimal schemes for intraperitoneal chemotherapy and evaluate the long-term effectiveness.

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