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Initial experience of pressurized intraperitoneal aerosol chemotherapy (PIPAC) in a French hyperthermic intraperitoneal chemotherapy (HIPEC) expert center.
Surgical Endoscopy ( IF 3.1 ) Pub Date : 2020-03-12 , DOI: 10.1007/s00464-020-07488-6
C Ceribelli 1 , T Debs 2 , A Chevallier 3 , M A Piche 3 , J M Bereder 1
Affiliation  

BACKGROUND Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new intraabdominal technique to approach non-resectable peritoneal carcinomatosis (PC). PIPAC can be performed alone or alternated with systemic chemotherapy to increase tumor regression. We describe our initial experience performed in an expert hyperthermic intraperitoneal chemotherapy (HIPEC) French center to demonstrate the safety and the feasibility of PIPAC. METHODS Between January 2016 and March 2019, PIPAC was proposed to 43 consecutive patients affected by digestive, ovarian, peritoneal and mammary carcinomatosis. Initially PIPAC was proposed to patients non eligible for cytoreductive surgery for palliative purposes. In five patients we associated PIPAC to systemic chemotherapy to improve tumor regression and enhance the chance of patients to undergo HIPEC. Three PIPAC treatments were supposed to be performed for each patient with an interval of 6 weeks in between each procedure. Peritoneal biopsies were always performed to evaluate microscopic tumor regression. In case of postoperative clinical deterioration or quick tumor progression during the cycles, PIPAC was interrupted. Depending on the primary tumor, chemotherapies used were oxaliplatin or a combination of cisplatin and doxorubicin. RESULTS Twenty-six (60.4%) patients have already had a surgical resection or intervention of primary cancer removal. In 5 patients abdominal access was impossible. Of the 38 patients operated, seventy-one procedures were performed. In the series, one patient died because of tumor progression. Only one major complication occurred intraoperatively. Two of thirteen patients receiving oxaliplatin had postoperative abdominal pain and needed more drugs assumption and a longer hospitalization. Three patients after a three cycles procedure underwent HIPEC. Nine of the patients who had at least two PIPACs had last biopsies showing a major or complete tumor response. CONCLUSION PIPAC is a safe and feasible procedure that can be performed in patients with peritoneal carcinomatosis initially not eligible for surgery to reduce tumor invasion or for palliation to reduce symptoms. Contraindications are bowel obstruction and multiple intraabdominal adhesions.

中文翻译:

在法国高温腹膜内化学疗法(HIPEC)专家中心内进行加压腹膜内气雾化学疗法(PIPAC)的初步经验。

背景技术加压腹膜内气雾化学疗法(PIPAC)是一种新的腹腔内技术,用于治疗不可切除的腹膜癌(PC)。PIPAC可以单独进行,也可以与全身化疗交替进行以增加肿瘤消退率。我们描述了我们在法国腹腔热化学疗法专家(HIPEC)法国中心进行的初步经验,以证明PIPAC的安全性和可行性。方法在2016年1月至2019年3月期间,将PIPAC推荐给43例连续的消化系统,卵巢,腹膜和乳腺癌病患者。最初,出于姑息目的,将PIPAC推荐给不适合进行细胞还原手术的患者。在五名患者中,我们将PIPAC与全身化疗相关联,以改善肿瘤消退并增加患者接受HIPEC的机会。假设每位患者应进行3种PIPAC治疗,每次间隔6周。总是进行腹膜活检以评估微观肿瘤消退。如果在该周期中术后临床恶化或肿瘤快速进展,则中断PIPAC。根据原发肿瘤,所用化学疗法是奥沙利铂或顺铂与阿霉素的组合。结果有26名(60.4%)患者已经进行了手术切除或原发癌切除术干预。在5例患者中,不可能通过腹部。在38例手术患者中,进行了71次手术。在该系列中,一名患者因肿瘤进展而死亡。术中仅发生一种主要并发症。接受奥沙利铂治疗的13例患者中有2例术后腹部疼痛,需要更多的药物治疗和更长的住院时间。经过三个周期的程序后,三名患者接受了HIPEC。至少有两次PIPAC的患者中有9位最近的活检显示有严重或完全的肿瘤反应。结论PIPAC是一种安全可行的方法,可以在最初不适合手术以减少肿瘤浸润或减轻症状的腹膜癌患者中进行。禁忌症是肠梗阻和腹部多处粘连。结论PIPAC是一种安全可行的方法,可以在最初不适合手术以减少肿瘤浸润或减轻症状的腹膜癌患者中进行。禁忌症是肠梗阻和腹部多处粘连。结论PIPAC是一种安全可行的方法,可以在最初不适合手术以减少肿瘤浸润或减轻症状的腹膜癌患者中进行。禁忌症是肠梗阻和腹部多处粘连。
更新日期:2020-03-12
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