New Technique May Help More Patients Receive PIPAC for Peritoneal Cancer
- Jul 28
- 2 min read
Pardo-Garcia C, Abadal JM, Galvez-Gonzalez E, Echegaray N, Cortes-Guiral D. Ultrasound-guided preoperative progressive pneumoperitoneum to facilitate pressurized intraperitoneal aerosol chemotherapy in inoperable peritoneal carcinomatosis. Eur J Surg Oncol. 2026 Jul;52(7):111870. doi: 10.1016/j.ejso.2026.111870. Epub 2026 May 13. PMID: 42143795.
Key Takeaway
A small new study suggests that a procedure called ultrasound-guided progressive pneumoperitoneum (PPP) may allow some patients who were previously unable to receive pressurized intraperitoneal aerosol chemotherapy (PIPAC) to become eligible for treatment. Although the study included only five patients, all were able to successfully undergo PIPAC after the procedure, with no serious complications reported.
Why This Matters
PIPAC is an emerging treatment option for some patients with peritoneal carcinomatosis (cancer that has spread to the lining of the abdomen). During PIPAC, chemotherapy is delivered as a pressurized aerosol during minimally invasive (laparoscopic) surgery, allowing the medication to coat the peritoneal surfaces.
However, not every patient is able to receive PIPAC.
In about 5% of patients, extensive scar tissue (adhesions) or a "non-accessible abdomen" prevents surgeons from safely inserting the laparoscopic instruments needed to perform the procedure. Until now, these patients often had no way to receive PIPAC.
What Is Progressive Pneumoperitoneum?
Progressive pneumoperitoneum (PPP) is a technique that has traditionally been used before complex hernia surgery.
In this study, doctors adapted the procedure for patients with peritoneal cancer by:
Placing a small catheter into the abdomen using ultrasound guidance
Slowly introducing controlled amounts of air over several sessions
Gradually creating enough space inside the abdomen for surgeons to safely perform laparoscopy and deliver PIPAC
What Did the Study Find?
Researchers prospectively treated five patients with inoperable peritoneal carcinomatosis who had previously been told their abdomens were not accessible for PIPAC.
The results were encouraging:
100% of patients successfully underwent PPP.
100% were then able to receive PIPAC or electrostatic PIPAC (ePIPAC).
There were no procedure-related complications.
No patients experienced serious adverse events or died within 30 days of treatment.
Patients tolerated repeated treatment cycles well.
What Does This Mean for Patients?
While this technique will not apply to most patients, it could make a meaningful difference for a small group of people who would otherwise be unable to receive PIPAC because of extensive abdominal adhesions.
By safely creating space within the abdomen before surgery, PPP may expand access to an important treatment option for selected patients with peritoneal metastases.
Important Limitations
This was a very small feasibility study involving only five patients at a single center.
Because of the limited number of participants, larger studies are needed before PPP becomes a standard part of care. Researchers will need to confirm that the procedure remains safe and effective in a broader group of patients.
The Bottom Line
This early research demonstrates a promising way to help certain patients with otherwise "non-accessible" abdomens become eligible for PIPAC. Although more research is needed, ultrasound-guided progressive pneumoperitoneum may expand treatment options for carefully selected patients with peritoneal carcinomatosis who previously had few alternatives.
