For patients with peritoneal surface malignancy who aren’t candidates for extensive cytoreductive surgery — whether due to the extent of disease, prior treatment, or overall fitness — PIPAC offers a different way to deliver chemotherapy directly to the peritoneal surface, with a much smaller surgical footprint. Rather than circulating heated liquid chemotherapy after major tumour removal, PIPAC delivers chemotherapy as a fine pressurised aerosol through a laparoscopic approach, allowing deeper and more even tissue penetration than a liquid instillation.

The procedure is performed laparoscopically, through small incisions, without an extensive resection. A specialised nebulising device disperses chemotherapy as an aerosol under pressure into the abdominal cavity, held in place for a defined period before being safely evacuated. Because the procedure is far less extensive than CRS-HIPEC, it can typically be repeated at intervals — often every four to six weeks — allowing an ongoing treatment strategy for disease that would otherwise be difficult to manage surgically.

Careful assessment of disease extent, including Peritoneal Cancer Index scoring, guides whether PIPAC is an appropriate option, and every case is discussed within a multidisciplinary tumour board — surgical oncology, medical oncology, and radiology working together to determine whether PIPAC fits within the broader treatment strategy, whether as a standalone approach or alongside systemic chemotherapy.