Carl Winkler, MD1, Jaspreet Sandhu, MD2, Dasuni Niyagama Gamage, MD1, Neil Mitra, MD1, Xiaohong Yan, PhD1, Hmc Shantha Kumara, PhD1, Nipa Gandhi, MD1, Richard Whelan, MD1. 1Mount Sinai West Hospital, 2Brookdale University Hospital Medical Center
Introduction: Most carcinomatosis patients (pts) with ovarian, colorectal, gastric, or appendiceal primary tumors are not candidates for cytoreductive surgery and HIPEC; most are treated with systemic (IV) chemotherapy (CT) which has notable morbidity and marginal responses. Because peritoneal implants are poorly vascularized, intra-lesion CT levels from IV CT are low vs. blood levels. PIPAC is an alternative palliative laparoscopic treatment approach that delivers an aerosol of CT directly into the peritoneal cavity under pressure (12 mmHg). This results in minimal blood elevations and a low rate of systemic complications. No cytoreduction is done. In ex vivo animal studies aerosolized CT has been shown to penetrate the peritoneum more deeply (100-200 um) than liquid CT. PIPAC is being used in Europe but not in the US. This poster will introduce this method and give a brief summary of results to date.
Method: A 12 mm Hassan port is placed via cut down; after insufflation a 5 mm port is placed. MIS exploration (PCI scoring) and implant biopsy are followed by administration of an aerosol of 1-2 CT agents via high pressure injector and aerosolizing device via the 12 mm port. Once infused, a 12 mmHg pneumo is maintained for 30 minutes after which the gas/aerosol is evacuated via filters into a canister and the ports removed. Discharge home is usually on postop day 1. PIPAC can be repeated (6 week intervals).
Results: As per the literature (16 series > 10 pts) PIPAC was successfully given to 627/709 (88.4%) who underwent a total of 1,408 PIPAC treatments for a variety of tumors (mean, 2.2 PIPAC/patient). The mean rate of grade 3 CTCAE (adverse events) was 6.5% per PIPAC (91/1408) and the 30 day mortality was 2%. The objective response rate as judged by serial biopsy, PCI score, or RECIST criteria was 45% overall; for the 145 pts who got ³2 PIPAC the response rate was 74%. The mean survival for this mixed group was 12.9 months. Of note, quality of life scores were maintained with PIPAC vs standard CT results. There have been no staff safety issues/problems.
Conclusion: PIPAC has been well tolerated with respectable response rates and low morbidity (vs IV CT). PIPAC allows pts to avoid IV CT and its higher morbidity. Prospective studies are underway to establish survival rates for each tumor type. A phase 1 FDA approved PIPAC trial will shortly begin in the US.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95031
Program Number: P673
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster