Pressurized Intra-Peritoneal Aerosol Chemotherapy (PIPAC) is a laparoscopic procedure of administration of aerosolized chemotherapy within the abdominal cavity, where the laws of physics allow a high tissue concentration of chemotherapy in the cancer cells, but without the usual side effects and toxicity of injected chemotherapy.
Pressurized Intra-Thoracic Aerosol Chemotherapy (PITAC) is the same procedure when used for chest for cancers that have spread to pleura.
MBBS, MRCSEd, DNB (Gen Surg),
MNAMS (Gen Surg), DNB (Surgical Oncology),
Fellowship in Laparoscopic and Robotic Onco-Surgery.
Dr Nayak is one of the leading senior Surgical Oncologists (cancer surgeon) of Bangalore. He is one of the pioneers of Laproscopic (laparoscopic) cancer treatment (surgery). He is the Director of Surgical Oncology at Fortis Hospital, Bangalore.
MBBS, MS, M.Ch
EDUCATION
MBBS from KIMS, Bangalore
MS from NHLMMC, Ahmedabad
M.Ch Surgical oncology from Tata Memorial hospital,Mumbai
WORK EXPERIENCE
Assistant Professor in RRMCH, Bangalore
is a surgical oncologist with interest in minimal access cancer surgeries. He finished his MCh (Surgical Oncology) training from Vydehi medical College and later did fellowship in minimal access and robotic Surgical Oncology. He has special interest in Breast cancers, Minimal access surgical oncology and Cytoreduction and HIPEC procedures. He has won award for best surgical video presentation in National conference and Best Abstract presentation in International conference, Korea.
The peritoneum lines the internal surface of the abdominopelvic wall (parietal peritoneum) and other organs inside the abdomen (visceral peritoneum).
The pleura lines the internal surface of the chest wall (parietal pleura) and lung (visceral pleura).
Mesothelioma originates in this layer. Like peritoneum many cancers can spread to this layer from other organs.
The cancers can originate in this layer:
Spread to this layer:
Peritoneal carcinomatosis represents end stage disease in many types of cancer when the cancer has spread in the peritoneum and no curative treatment (like HIPEC) is possible for various reasons. Majority of patients with this will die from their disease within six months. Chemotherapy may prolong survival in selected patients, but poor performance status, low response rates, and toxic side effects of chemotherapy have led to conservative treatment strategies in these patients. The same happens when cancer is spread (metastasis) to chest cavity (pleura) as well. Thanks to recent research efforts, we dispose nowadays of an efficient alternative therapy with less surgical risks and only little impact on quality of life.
Patients with Peritoneal or pleural carcinomatosis, who are in good condition and with a remaining life expectancy of more than a few months, may still have an unmet need for additional treatment in order to be able to perform with a high quality of life for as long as possible. These are the patients who may benefit from PIPAC or PITAC. PIPAC and PITAC are likely to improve their quality of life with very few side effects.
PIPAC can only be applied by laparoscopy. The fumigation as a gas allows a homogeneous dispersion of chemotherapy within the peritoneal cavity or pleural cavity. The administration of chemotherapy under pressure increases the local tissue penetration of the chemotherapy allowing high concentrations in cancer cells. The procedure is performed under general anesthesia. Two trocars or tubes are inserted via two small incisions (5-12 mm) into the peritoneal cavity. Carbon dioxide insufflation grants the necessary workspace. First, small tissue samples of the tumor knots are retrieved (biopsy). Then, the chemotherapy is dispersed as pressurized aerosol inside the abdominal or chest cavity for 30 minutes. At the end of the procedure, the pressure is released and the gas aspirated, and the skin incisions are closed.
The whole procedure lasts about 90 minutes. The length of hospital stay is usually 3-4 days. Three applications of PIPAC or PITAC are recommended within 3 months with a delay between the applications: 4-6 weeks. Alternatively, this can be interspersed with chemotherapy between every second cycle. All patients are observed closely during the therapeutic cycle.
