PIPAC Therapy is an innovative approach to regional chemotherapy.

High-dose drugs are aerosolized directly into the abdominal cavity. PIPAC treatments are administered in the Surgical Oncology Department at the Sheba Medical Center by experienced physicians who have undergone specialized training.

The use of PIPAC treatment in combination with systemic chemotherapy allows for the control of peritoneal metastases with fewer side effects. This modern form of treatment is particularly effective as palliative therapy and as a means of limiting the spread of cancer that has not reached the terminal stage.

How PIPAC Works:

PIPAC therapy is a minimally invasive laparoscopic procedure performed under general anesthesia. The revolutionary technology utilizes a video camera and a specialized device called the CapnoPen. The CapnoPen is an atomizer that converts chemotherapy drugs into an aerosol under high pressure. This device was originally developed for the automotive industry as a fuel injection technology.

Before undergoing PIPAC, biopsies of the abdominal cavity are taken, and the Peritoneal Cancer Index (PCI) is determined using a video method. Performing these procedures together ensures both an objective and subjective analysis of the patient’s response to chemotherapy.

The CapnoPen is connected to an injector and placed in the abdominal cavity through a trocar (surgical access port). Chemotherapy is then aerosolized for 30 minutes (cytotoxic drugs are prescribed based on the underlying disease). At the end of the session, the aerosol is suctioned out through a filtering system. In total, PIPAC takes about one hour.

In most cases, patients stay overnight in the hospital for observation after the procedure. PIPAC is generally well-tolerated. Repeat injections of chemotherapy are typically performed every six weeks. Patients usually undergo 3 PIPAC procedures before reassessment.

Advantages of Aerosol Chemotherapy:

Due to the combination of high pressure and fine aerosol particles, the drug penetrates deeper into the tumor, requiring lower doses.

The aerosol spreads more evenly in the abdominal cavity, surrounding the tumor and preventing its spread.

PIPAC may be a suitable treatment for patients with the following cancers:

  • Peritoneal metastases from malignant tumors of the stomach, colon, pancreas, liver, and appendix.
  • Mesothelioma.
  • Ovarian cancer with metastases to the abdominal cavity.
  • The primary goal of PIPAC is to improve survival and quality of life in patients with these conditions.


Indications for PIPAC Treatment:
PIPAC therapy is indicated for patients with peritoneal metastases when the following factors are present:

Severe adverse effects caused by systemic chemotherapy:

  • Lack of response to systemic anti-tumor therapy.
  • The presence of significant and difficult-to-treat ascites (accumulation of free fluid in the abdominal cavity).
  • Cytoreductive surgery (CRS) is contraindicated due to extensive disseminated disease.
  • Hyperthermic intraperitoneal chemotherapy (HIPEC) is contraindicated due to the widespread pathological process.

Contraindications for PIPAC Treatment:

  • Multiple past abdominal surgeries.
  • Presence of metastases beyond the abdominal cavity.
  • Low functional status.
  • Presence of small bowel or biliary tract obstruction.


Possible Side Effects of PIPAC Treatment:
The quality of life in patients with peritoneal metastases who underwent PIPAC has been studied. Results were excellent with stabilizing aspects. In most cases, no deterioration in gastrointestinal symptoms was observed, and pain was transient. Side effects of systemic chemotherapy (such as severe nausea, vomiting, diarrhea, mucositis, and hair loss) were mostly not observed.