Clinical research on PIPAC is still evolving and in an early stage, consisting primarily of Phase I-II clinical trials and international registry studies rather than randomized Phase III evidence. Early studies suggest that PIPAC can be given safely multiple times and is generally well tolerated. In some carefully selected patients with peritoneal cancer, it has shown promising results in slowing cancer growth and shrinking tumors, while causing relatively few serious side effects throughout the rest of the body.Early-phase trials in ovarian, gastric, and colorectal cancers have also demonstrated that repeated treatment cycles can be delivered safely, even for patients who have already received several previous treatments, early studies suggest that PIPAC may be a safe, minimally invasive option for delivering chemotherapy directly into the abdomen.

Current Results

Across larger pooled datasets, severe complications generally occur in approximately 4-17% of patients, while procedure-related mortality is low (~1-2%), supporting a favorable safety profile compared with more invasive surgical approaches, such as CRS/HIPEC. How well PIPAC works can depend on the type of cancer, how far it has spread, and the treatments a patient has already received. In early studies, about 60–70% of patients showed signs that their tumors were responding to treatment under the microscope. Patients who were able to complete several PIPAC treatments often had even better results. However, overall success is still unclear. Radiologic response rates and peritoneal cancer decline are more variable, reflecting differences in patient selection and study design. The average overall survival ranges from 8-19 months from treatment initiation, with slightly better outcomes observed in patients able to complete 3+ PIPAC cycles. However, there is currently no high-level evidence proving a survival advantage.

Quality of Life

One of the main goals of this treatment is to maintain quality of life in a palliative setting. Although quality-of-life-data remain limited, most studies show that overall quality of life is maintained during treatment for the majority of patients, rather than declining as often seen with more aggressive therapies in advanced disease. This may be related to the low levels of treatment-related side effects, including nausea, fatigue, and neuropathy, resulting from limited systemic drug absorption. In addition, the minimally invasive nature of the procedure and relatively rapid recovery between treatments often allow patients to maintain daily activities and continue systemic therapy when appropriate.

Limitations & Future Directions

Current research is increasingly focused on optimizing drug combinations, dosing amount and frequency, and treatment intervals, as well as exploring how PIPAC can be integrated with systemic chemotherapy or used as a bridge to potentially curative surgery in selected patients. However, important gaps remain. There are no completed Phase III trials demonstrating a survival benefit, no universally accepted treatment protocol, and limited head-to-head comparisons with HIPEC or modern systemic chemotherapy. As a result, key uncertainties remain around ideal patient selection, long-term outcomes, and where PIPAC fits in the overall treatment sequence for peritoneal metastases.