PIPAC vs HIPEC: What’s the Difference? |MACS

PIPAC and HIPEC both put chemotherapy straight into the abdomen instead of sending it through the blood, but they’re very different treatments. HIPEC is a major operation: surgeons remove the visible tumor, then bathe the abdomen in heated chemo, mostly aiming at cure. PIPAC is a keyhole procedure that sprays a small dose of chemo as a mist, repeated every few weeks, mostly to hold back cancer that can’t be operated on.

Dr. Sandeep Nayak, who provides the best cancer treatment in Bangalore, says patients almost always ask which one is better. “That’s the wrong question. HIPEC is for the person whose cancer we can actually remove completely. PIPAC is for the person for whom that operation is no longer safe or sensible. So we look at how much disease is in the abdomen, how strong the patient is, and how the cancer has behaved so far. Then we choose.”

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The HIPEC Procedure: Major Surgery Aimed at Cure

HIPEC is really one long operation in two parts, and the surgery is the bigger half:

Surgery comes first. The team removes every visible tumor from the lining of the abdomen. This is called cytoreductive surgery, and without it the heated chemo wouldn’t do its job.
Then the abdomen is bathed in warm chemo. The drug is heated to around 41 to 43°C and circulated for about an hour to an hour and a half, while you’re still under anesthesia. The heat helps the drug reach cells that are too small to see.
It’s a big undertaking. The whole operation can run anywhere from 6 to 12 hours. It’s done once, not in cycles, and recovery takes weeks.
It works best when the disease is limited and fully removable. Doctors score the spread with the Peritoneal Cancer Index to decide. It’s mainly used for cancers of the appendix, colon, rectum and ovary, along with pseudomyxoma and mesothelioma. Our HIPEC page explains the full process.

PIPAC vs HIPEC Difference: The PIPAC Procedure and Who Gets Which?

PIPAC is a newer, lighter idea, and it plays a different role:

It’s done through keyhole surgery. A surgeon makes a couple of small cuts, looks around inside with a camera, takes biopsies, and then sprays the chemo as a fine mist at body temperature for about half an hour. The leftover drug is then safely drawn out through a closed system. This is the PIPAC procedure in a nutshell.
The dose is small, and it’s repeated. It’s roughly a tenth of the usual chemo dose, so side effects tend to be milder. It’s repeated about every six weeks, often alongside regular chemo, and the biopsies show how the cancer is responding.
The goal is control, not cure, at least for now. PIPAC doesn’t remove the tumor. It was introduced around 2011, and the evidence so far comes from smaller studies, so it’s still considered experimental in many places. Our PIPAC page explains where it fits.
A rough rule for who gets which. If the spread is limited and you’re fit enough for a big operation, CRS with HIPEC is usually the first thing to consider. If the disease is too widespread to remove, or you’re too unwell for major surgery, PIPAC may be an option. Both come up often in ovarian cancer and colorectal cancer.

What Determines the Right Treatment Approach?

Choosing between PIPAC and HIPEC depends on the individual case, and the treating team reviews several things together.

The primary cancer. Colorectal, appendix, ovarian and stomach cancers that spread to the peritoneum behave differently, and each has its own evidence base.

How far the disease has spread. The extent of peritoneal involvement, often scored on imaging or at laparoscopy, shows whether the disease can be removed surgically.

Whether complete removal is possible. HIPEC is combined with cytoreductive surgery, so it generally suits patients whose visible disease can be removed. PIPAC is usually considered when that is not feasible.

Overall health and earlier treatment. Fitness for a long operation, organ function and previous chemotherapy all affect what is safe.

Response to chemotherapy so far. How the cancer has behaved on treatment helps guide the choice.

Review by the wider team. Surgical, medical and radiation oncology usually review the scans and records together before a plan is written.

Because these factors differ for each person, the choice is made case by case after reviewing the scans and records.

Key Takeaways

PIPAC and HIPEC are two different ways of delivering chemotherapy inside the abdomen. Neither is right for everyone.
HIPEC is combined with major surgery and suits patients whose disease can be removed. PIPAC is usually considered when that is not possible.
The choice depends on the primary cancer, how far it has spread, overall health and earlier treatment.
Scans and records are reviewed together by the treating team before a plan is made.
For questions about your own case, you can contact the clinic at +91 9482202240.

FAQs

Is PIPAC better than HIPEC?

Neither is better across the board. HIPEC is for patients whose cancer can be fully removed by surgery. PIPAC is generally for those where it can’t. They answer different situations.

Can PIPAC cure peritoneal cancer?

At present it’s mainly used to control disease and ease symptoms, not to cure. Researchers are studying whether it can do more, but that isn’t settled yet.

How is recovery different after PIPAC and HIPEC?

HIPEC comes with a very large operation, so expect a hospital stay of a week or more and several weeks to recover. PIPAC is keyhole surgery, so the stay is usually shorter and recovery quicker.

Which cancers are treated with HIPEC and PIPAC?

Mostly cancers that have spread to the lining of the abdomen from the ovary, colon, rectum, appendix or stomach. HIPEC is also used for mesothelioma and pseudomyxoma peritonei.

Reference

Disclaimer:

This content is published for educational and informational purposes only and is not a substitute for medical advice. Please consult your doctor before changing any treatment.

PIPAC vs HIPEC: What’s the Difference?