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MINIMALLY INVASIVE PERITONEAL ONCOLOGY
PIPAC
Pressurised Intraperitoneal Aerosol Chemotherapy
A revolutionary laparoscopic procedure that delivers chemotherapy as a fine mist under pressure directly to the peritoneum — offering treatment for patients with inoperable peritoneal cancer and a potential bridge to curative surgery.
Repeatable Every 4–6 Weeks
Low Systemic Side Effects
Bridge to HIPEC
Laparoscopic
Keyhole Surgery
4–6 weeks
Repeat Interval
1–2 days
Hospital Stay
ESSO Trained
Hannover, Germany
WHAT IS PIPAC?
Aerosolised Chemotherapy Delivered Directly to the Peritoneum
PIPAC (Pressurised Intraperitoneal Aerosol Chemotherapy) is a cutting-edge laparoscopic procedure in which chemotherapy drugs are converted into a fine aerosol and delivered under CO₂ pressure directly into the closed abdominal cavity. This creates a uniform drug distribution across the entire peritoneal surface — including areas that are technically difficult to reach surgically.
Unlike HIPEC — which requires major open surgery (CRS) — PIPAC is performed through keyhole (laparoscopic) ports. The procedure takes approximately 90 minutes, and patients are typically discharged within 24–48 hours. Because it is repeatable every 4–6 weeks, PIPAC allows sustained peritoneal drug exposure with low systemic toxicity.
PIPAC was developed in Germany and Dr. Imaduddin underwent his PIPAC training as part of his ESSO Fellowship under Prof. Dr. Beate Rau at University Hospital Hannover — the centre where much of the clinical evidence for PIPAC was established.
PIPAC vs. HIPEC — Key Differences
Key advantage: PIPAC can be offered to patients with disease too advanced for immediate CRS + HIPEC, providing treatment and enabling disease response assessment over serial sessions.
WHO BENEFITS FROM PIPAC?
Indications for PIPAC
PIPAC is primarily used for patients with peritoneal metastases who are not immediately candidates for CRS + HIPEC — due to disease extent, systemic disease, or prior treatment history.
🔵 Unresectable Peritoneal Metastases
Patients with high PCI scores or disease involving critical structures who are not candidates for upfront CRS + HIPEC can receive PIPAC as palliative or disease-modifying treatment.
🟡 Bridge Therapy to CRS + HIPEC
Serial PIPAC sessions (typically 3) can reduce peritoneal tumour burden, converting some patients from inoperable to operable — enabling subsequent curative CRS + HIPEC.
🟠 Gastric Cancer Peritoneal Spread
Gastric cancer with peritoneal metastases has a particularly poor prognosis with systemic chemotherapy alone. PIPAC using cisplatin + doxorubicin offers a novel palliative option.
🟤 Recurrent Ovarian Cancer
Patients with platinum-resistant recurrent ovarian peritoneal disease can benefit from PIPAC using carboplatin, with histological response monitoring each cycle.
TRAINED AT THE SOURCE
PIPAC Expertise from the Centre That Pioneered It
🇩🇪 ESSO FELLOWSHIP · HANNOVER, GERMANY
Dr. Imaduddin trained in PIPAC as part of his ESSO Fellowship in Peritoneal Surface Malignancy under Prof. Dr. Beate Rau at University Hospital Hannover — where much of the global PIPAC research and clinical protocols were developed and validated.
This makes Dr. Imaduddin one of the very few surgical oncologists in Hyderabad and Telangana trained in PIPAC from a European centre of excellence — bringing this novel technique to patients in South India who previously had no access to it.
PIPAC PROCEDURE OVERVIEW
Laparoscopic Access
Two or three small ports (5–12mm) are placed. CO₂ is used to create a pneumoperitoneum. Peritoneal biopsies are taken to assess tumour response.
Aerosol Delivery
A PIPAC nebuliser device converts the chemotherapy solution into a fine aerosol, which is injected under pressure (12 mmHg) and distributes evenly across all peritoneal surfaces.
Dwell Time (30 min)
The aerosol dwells for 30 minutes at intra-abdominal pressure, allowing deep tissue penetration into the peritoneum. This is the key mechanism of enhanced drug uptake.
Safe Desufflation & Discharge
The gas is safely filtered through a closed exhaust system, ports removed, and the patient recovers overnight. Most patients are discharged within 24–48 hours.
Is PIPAC an Option for You?
If you or a family member has been diagnosed with peritoneal metastases — whether from colorectal, ovarian, gastric, or another cancer — Dr. Imaduddin can assess whether PIPAC, HIPEC, or a combination approach is most appropriate.