S15 Ep11: PIPAC Reshapes Peritoneal Cancer Surgery Workflows and Outcomes: With Gregory J. Tiesi, MD, FACS, FSSO; Anthony Scholer, MD, FACS, FSSO; Benjamin Jon Golas, MD, FACS; and Eric Pletcher, MD

In this episode, Gregory J. Tiesi, MD, FACS, FSSO, hosted a discussion about innovations in regional cancer therapies. Dr Tiesi is the medical director of Hepatobiliary Surgery at the Hackensack Meridian Jersey Shore University Medical Center in Neptune, New Jersey. He was joined by: Anthony Scholer, MD, FACS, FSSO, a surgical oncologist specializing in hepatobiliary surgery, at Hackensack Meridian Medical Group and Jersey Shore University Medical Center in Neptune, New Jersey Benjamin Jon Golas, MD, FACS, regional chief of Surgical Oncology for Hackensack Meridian Health’s Central Region, surgical director of Oncology Services at Jersey Shore University Medical Center, vice chair of Surgery at Jersey Shore University Medical Center Cancer Surgery, and an associate professor of surgery at the Hackensack Meridian School of Medicine in Nutley, New Jersey Eric Pletcher, MD, a surgeon specializing in Complex General Surgical Oncology at Hackensack Meridian JFK University Medical Center in Edison Drs Tiesi, Scholer, Golas, and Pletcher chatted about the use of pressurized intraperitoneal aerosolized chemotherapy (PIPAC), a minimally invasive regional cancer therapy designed for patients with peritoneal metastases or primary peritoneal cancers. The experts explained that this laparoscopic approach overcomes several limitations of traditional systemic treatments by delivering aerosolized chemotherapy in fine droplets under high pressure into the peritoneal cavity. This process ensures uniform drug distribution and enhanced tissue penetration, allowing for efficacy with lower systemic drug concentrations, they noted. PIPAC candidates typically present with unresectable or recurrent disease, or symptomatic malignant ascites, and should have an ECOG performance status between 0 and 2, they elaborated. The procedure, which is repeatable every 4 to 6 weeks, includes diagnostic laparoscopy, quantification of the peritoneal carcinomatosis index, and serial biopsies to assess treatment response. They emphasized that PIPAC has a favorable safety profile, with low 30-day mortality rates and minimal grade 3/4 adverse effects reported in clinical trials. Additionally, they stated that clinical data indicate high pathologic response rates and the potential for disease downstaging, enabling some patients who were initially deemed unresectable to become eligible for subsequent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Of note, the experts reported that PIPAC is designed to be integrated seamlessly with concurrent systemic therapy.