Objectives:Pseudomyxoma peritonei (PMP) is a rare peritoneal malignancy characterised by progressive accumulation of mucin within the abdomen. The gold standard of PMP treatment is cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). BromAc® is a mucolytic therapy developed for patients with inoperable PMP but its efficacy is reduced with hard mucin. Shear wave elastography (SWE) is an ultrasound technique that quantifies the mechanical and elastic properties of tissues. It was hypothesised that SWE could provide a preoperative, objective assessment of mucin consistency. Methods:A retrospective pilot study of patients with PMP who underwent SWE prior to CRS-HIPEC was conducted. All patients underwent elastography at a specialised radiology practice. SWE results across the four quadrants of the abdomen were compared with intraoperative assessment of mucin consistency. Results:The study yielded 12 eligible patients between Jan 2020 to Apr 2025. The mean SWE value for hard mucin was 5.9 kPa compared with 4.5 kPa for soft. This difference was not statistically significant (p=0.64). Conclusions:There is a clinical need for an objective assessment of mucin consistency in patients with PMP. While limited by its small sample size, this study found that the mean SWE result for hard mucin was slightly higher than for soft.
Objectives:Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is an established treatment for selected patients with colorectal peritoneal metastases (CPM). The recently proposed concept of textbook oncologic outcomes (TOO) offers a composite benchmark for surgical quality, but its applicability and prognostic relevance in CPM remain largely unexplored. Methods:We conducted a retrospective single-centre analysis of all patients undergoing CRS and HIPEC for CPM between 2007 and 2025. Primary endpoint was overall survival (OS); secondary analyses assessed individual TOO components and associated factors. Results:Eighty-four patients met inclusion criteria (age 54.1 ± 12.1 years, PCI 5.8 ± 4.5). CC0 resection was achieved in 88.1 %, severe postoperative complications occurred in 34.5 %, and reoperation was required in 20.2 % of patients. Ninety-day mortality was 1.2 %. Complete TOO was achieved in 14.3 % of patients as only 31/84 were recommended adjuvant chemotherapy. Median OS was 39.2 months. Absence of reoperation (p=0.02), and negative lymph node status (p=0.04) were significantly associated with improved OS. Conclusions:TOO was achieved in <50 % of patients, mainly due to the absence of adjuvant chemotherapy. Absence of reoperation was associated with survival, suggesting its validity as quality indicator. Refinement of TOO definitions, incorporating patient-centred recovery measures, may improve their applicability.
Objectives:Peritoneal metastases (PM) represent a significant unmet need requiring urgent development of treatment options to improve patient prognosis and quality of life (QoL). A novel anti-cancer technology is Pressurised IntraPeritoneal Aerosolised Chemotherapy (PIPAC). PIPAC aims to improve target specificity of anti-cancer therapies by delivering medication as an aerosol directly to the peritoneum at laparoscopy. Early phase I/II studies suggest that PIPAC has the potential to improve treatment efficacy and cancer outcomes whilst maintaining or improving QoL through less systemic drug absorption. PICCOS aims to determine whether PIPAC can improve peritoneal progression free survival (pPFS) in patients with PM from, compared to SACT alone. Methods:PICCOS is a phase II, multi-centre, superiority, randomised controlled trial (ISRCTN 17575409). It aims to determine whether PIPAC (given alone or in combination with systemic anti-cancer therapy (SACT)) can improve peritoneal progression free survival (pPFS) as per RECIST (V1.1) in patients with PM, compared to SACT alone. Key secondary outcome measures include quality of life, safety, overall survival and progression free survival. 216 patients with non-resectable PM from colorectal cancer, platinum resistant ovarian cancer and gastric cancer will be recruited. Patients will be randomised to receive either standard of care SACT alone or PIPAC in combination with (colorectal, gastric groups) or without (ovarian group) standard of care SACT. Median pPFS will be estimated using the Kaplan-Meier method. The log-rank test, stratified by prognostic factors, will be used to compare PFS distributions. Results:PIPAC is expected to achieve improved peritoneal progression free survival for patients in comparison to those treated with standard care. Conclusions:PICCOS aims to provide much needed, high-quality evidence on the efficacy of PIPAC in treating PM.
Objectives:Malignant bowel obstruction (MBO) caused by advanced peritoneal metastases (PM) carries a poor prognosis. Surgical intervention may be the only therapeutic option in selected cases, but operative risks must be carefully balanced against potential benefits. This study aimed to evaluate the outcomes of patients undergoing surgery for MBO secondary to PM. Methods:Single-centre retrospective analysis of consecutive patients operated for MBO of various origins between 2016 and 2021. The primary outcome was overall survival (OS). Secondary outcomes included postoperative morbidity, resumption of systemic chemotherapy, and incidence of re-obstruction. Results:A total of 27 patients (median age 64 years, 67 % female) were included. Median peritoneal cancer index (PCI) was 32, and ascites was present in 16 patients (59 %). Surgical resolution of obstruction was achieved in 24 patients (88 %) via bowel resection (n=10), internal bypass (n=7), stoma formation (n=5), or adhesiolysis (n=2). Severe morbidity occurred in 26 %, with no postoperative mortality. Five patients (19 %) required reoperation, and three (11 %) developed enterocutaneous fistulae. Median OS was 4.0 months (IQR 9.4). Survival rates at 3, 6, and 12 months were 56 , 37, and 26 %, respectively. Postoperative systemic chemotherapy was resumed in 19 patients (70 %), significantly more often among those surviving >6 months (p=0.02). Re-obstruction occurred in 14 patients (52 %). Conclusions:Surgery is a feasible and valid therapeutic option for selected patients with MBO due to advanced PM. Despite considerable morbidity, most patients are able to resume systemic chemotherapy, which may contribute to improved survival outcomes.
Objectives Ovarian cancer (OC) often presents with peritoneal metastases (PM) which contribute significantly to morbidity and treatment resistance. Pressurized intraperitoneal aerosolized chemotherapy (PIPAC) has emerged as a promising modality for locoregional drug delivery in peritoneal surface malignancies. Historically, combined intraperitoneal (IP) and intravenous (IV) cisplatin and paclitaxel regimens have demonstrated activity in first-line OC treatment. PIPAC nab-paclitaxel and cisplatin with systemic nab-paclitaxel holds promise as a safe and effective therapy, but has not been explored in OC. Methods This ongoing, dose de-escalation, single-arm phase I study evaluates triplet bidirectional chemotherapy with a safety lead-in (NCT04329494). The study evaluates the safety and tolerability of a 28-day cycle of Day 1 PIPAC nab-paclitaxel 90 mg/m 2 and cisplatin 15 mg/m 2 in combination with Days 8 and 15 IV nab-paclitaxel 100 mg/m 2 for three cycles in recurrent OC patients with unresectable PM. Results Enrollment is ongoing at U.S. academic centers. The primary endpoints are dose-limiting toxicities and adverse events. Secondary endpoints include radiographic (RECIST v1.1), histologic, and surgical response, progression-free and overall survival, and post-operative complications. Conclusions This study investigates the safety, feasibility, and preliminary activity of the combination of PIPAC and systemic IV chemotherapy in recurrent OC patients to determine efficacy and safety for a future Phase II trial.
Objectives The immunology of peritoneal mesothelioma (PeM) is complex, with the tumor microenvironment (TME) playing a crucial role in disease progression. PeM frequently evades immune detection by altering the TME. Methods This pilot study analyzed archival peritoneal biopsies from three patients with epithelioid PeM treated with intraperitoneal chemotherapy. Using immunohistochemistry and digital image analysis, we evaluated immune cell populations (T cells, B cells, and macrophages) across 19 time points, encompassing 20 histology (HE) sections, 140 immunohistochemistry (IHC) sections, and 1,120 measurement areas. Seven markers quantified immune cell infiltration in the tumor and the peritumoral regions. Results Distinct immune marker patterns in the tumor and TME were identified, suggesting immune cell movement and activity changes at early therapy stages. Key markers, such as CD4 and CD8, exhibited correlated trends between tumor and TME, indicating synchronized immune responses. Early shifts in these markers suggested migration from the tumor to the TME, while CD68 and CD163 showed variable patient-specific patterns, potentially reflecting individual immune responses. Elevated immune marker levels correlated negatively with survival, suggesting advanced disease progression in some cases. Conclusions This study is the first to explore sequential TME changes in PeM under treatment. PeM may evade immune response by modifying the TME, varying among patients. PIPAC’s ability to enable repeated biopsies provides a valuable approach to advancing personalized PeM therapy. Further studies are needed to confirm and specify our findings.
Objectives:Malignant pleural effusion is a common evolution of various cancers and is associated with poor prognosis and quality of life. Currently, the surgical approach is mainly palliative, involving videothoracoscopic talc pleurodesis or the insertion of indwelling pleural catheters. No surgical options with a curative intent are validated for this indication. The aim of our study was to evaluate a score for assessing resectability in pleural carcinomatosis. Methods:122 consecutive patients with recurrent symptomatic pleural effusion, referred to our thoracic surgery department for a surgical exploration of the pleura, were prospectively included. Each patient underwent a detailed description of videothoracoscopic findings, which were summarized in our pleural carcinomatosis score. Resectability was then discussed in our surgical staff meeting. Results:Eighty patients (65.6 %) were diagnosed with metastatic pleural spread, while 42 patients were diagnosed with benign pleural disease (34.4 %). Patients diagnosed with benign pleural effusion had a median score of 2, and 29 patients (69 %) were considered resectable. Patients diagnosed with malignant pleural effusion had a median score of 11, and only 13 patients (16.2 %) were considered resectable. Those deemed resectable had a median score of 5. The threshold for resectability in our score was set at 6. Conclusions:The meticulous exploration of the pleura and calculation of the pleural carcinomatosis score could aid in selecting patients for curative-intent surgery. Patients with a score equal to or less than 6 should be discussed in a multidisciplinary tumor board where the possibility of surgery is considered.
Objectives:Pseudomyxoma peritonei (PMP) is a rare, slow-growing cancer with few efficacious treatment options in unresectable cases. Mutations in the KRAS and GNAS oncogenes are common, but the reported frequencies vary greatly, most likely because of low tumor cellularity in peritoneal tumor samples. With treatments targeting these mutations becoming increasingly available, reliable detection of mutations is essential. Methods:The frequency of KRAS and GNAS mutations was analyzed in tumor samples from 167 patients with verified PMP using targeted DNA sequencing and/or droplet digital polymerase chain reaction. When analysis of fresh-frozen peritoneal tumor samples did not reveal mutations, macrodissected formalin-fixed samples were analyzed. Results:Mutations in cancer-related genes were detected in 98 % of the analyzed samples, with KRAS and GNAS mutated in 148 (89 %) and 139 (83 %) cases, respectively. In 48 % of the analyzed cases, the mutational diagnosis was based on primary tumor samples. Conclusions:High frequencies of KRAS and GNAS mutations support the proposed role as driver mutations and as potential therapy targets. The primary tumor may serve as an alternative source of tumor material, increasing the likelihood of detecting targetable mutations. Combined with highly sensitive analytical methods, this approach facilitates selection of patients for novel targeted therapeutic strategies.
Objectives To evaluate current postoperative management strategies for incidentally discovered, completely resected low-grade appendiceal mucinous neoplasms (LAMNs) within the French RENAPE network and to assess the need for a new national consensus.Methods A national survey was conducted among RENAPE expert centers using a structured questionnaire based on standardized postoperative risk scenarios. Survey items addressed surveillance strategies, indications for reoperation, and use of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC).Results Ninety-one percent of centers responded. All reported systematic multidisciplinary discussion, centralized pathology and imaging review, standardized imaging, and tumor marker assessment. Marked heterogeneity was observed. For low-risk patients (R0 resection, no perforation, no extra-appendiceal mucin), 50 % recommended no follow-up and 50 % proposed long-term MRI surveillance. In intermediate-risk cases (limited perforation or adjacent mucin), 80 % favored MRI follow-up, while 20 % recommended diagnostic laparoscopy or prophylactic CRS-HIPEC. In high-risk scenarios with radiologic suspicion of implants, 60% proposed early CRS-HIPEC, whereas others preferred laparoscopic assessment or surveillance.Conclusions This survey highlights wide variation in postoperative strategies for LAMNs within RENAPE, especially in intermediate-risk cases. While consensus exists on centralized review and imaging, significant evidence gaps persist regarding prophylactic HIPEC. These findings underscore the need for harmonized, evidence-based protocols and prospective data collection.
Objectives:The effects of preoperative chemotherapy have been poorly studied in colorectal cancer with peritoneal metastases (CRC-PM). This study evaluated preoperative chemotherapy from the first multi-disciplinary team meeting (MDT) decision, focusing on the response rates, surgical outcomes, and survival. Methods:This retrospective cohort study analyzed consecutive patients with resectable or potentially resectable CRC-PM evaluated at Uppsala University Hospital's peritoneal-MDT between March 2019 and December 2023. Kaplan-Meier curves and Cox-regression analyses were used for survival analysis. Results:Of 179 patients, 81 underwent upfront surgery; 52 received doublet chemotherapy and 46 received doublet with targeted therapy. Targeted group showed a 52 % overall response rate vs. 36 % for doublet group (p=0.14), with patients selected for CRS and HIPEC at a 52 % vs. 31 % rate, respectively, p=0.086. The median overall survival was superior in the targeted group than in the doublet group (intention-to-treat with all patients included): 21 (95 %CI: 18-35) vs. 17 (95 %CI: 14-22) months (p=0.027). The VEGF-targeted therapy outperformed EGFR-targeted therapy: 32 (95 %CI: 21-Not reached) vs. 15 (95 %CI: 11-40) months (p=0.042). Conclusions:Preoperative chemotherapy with targeted antibodies improves overall survival in CRC-PM in patients that are not candidates for upfront CRS and HIPEC. Bevacizumab is associated with improvement over EGFR targeted treatment in a subgroup analysis.
Objectives:Pseudomyxoma peritonei (PMP) is a rare peritoneal malignancy. BromAc ® is a novel therapeutic agent which has been developed to dissolve and facilitate the drainage of mucin as a palliative treatment for PMP; however, its effect is significantly reduced in patients with hard mucin. This study aimed to assess whether combining collagenase or cysteamine with BromAc ® would be more effective in dissolving hard mucin. Methods:This preclinical human in vitro study examined the effect of adding collagenase to BromAc ® on hard mucin samples when incubated at 37 °C over 24 h. The effect of cysteamine alone and in combination with collagenase and BromAc ® was also examined as a supplementary arm of this study. Five experiments were conducted with appropriate controls. Human hard mucin samples were sliced into equal fractions using a sterile surgical scalpel, weighed and noted. The leftover solid mucin was weighed at 0, 1, 3, 5, and 24 h post-treatment. Results:At 24 h post-treatment, all combinations with collagenase demonstrated almost 100 % dissolution of hard mucin. At 3 and 5 h post-treatment, only BromAc ® with collagenase at 250 μg/mL was found to be superior to BromAc ® alone. Combinations with cysteamine were not found to be effective. Conclusions:This study provides promising evidence of the efficacy and synergistic effect of combining BromAc ® with collagenase to dissolve hard mucin. Further preclinical and clinical research should be undertaken to assess its safety and efficacy in the clinical setting.
Objectives:Peritoneal mesothelioma (PM) shares features with genitourinary (GU) malignancies, including histologic appearance, embryologic origin and genetic predispositions. However, data on their co-occurrence are limited. The study presents a case series of PM patients with associated GU malignancies and explores outcomes following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). Methods:A prospectively maintained CRS-HIPEC database from a tertiary referral center (2011-2024) was reviewed. Demographics, tumor characteristics and outcomes were compared between PM patients with and without GU malignancies (including gynecologic and urologic cancers). Results:Among 237 CRS-HIPEC patients, 8/17 patients with PM were found to have another GU malignancy (median age 52.8, 62.5 % male). This included renal cell carcinoma, prostate cancer, ovarian tumors and cervical carcinoma. Most GU malignancies were diagnosed before PM (5/8), two were diagnosed post-CRS-HIPEC, and one synchronously. Three patients reported asbestos exposure; two had BAP1 mutations. Compared to those without GU malignancies, affected patients tended to have higher PCI (19.8 vs. 14.3) and poorer 3-year survival (62.5 vs. 100 %). Conclusions:GU malignancy is common among PM patients undergoing CRS-HIPEC and could represent a higher-risk subgroup. These findings raise the hypothesis of a potential association between PM and GU malignancy. Shared origins, oncogenesis of similar cell types, environmental exposures or genetic predispositions may contribute and warrant further investigation.
Introduction Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is an innovative intraperitoneal drug delivery technique utilizing a nebulizer to aerosolize liquid chemotherapy agents under pressure, distributing them evenly throughout the peritoneal cavity to achieve therapeutic effects. As increasing clinical evidence supports the safety and efficacy of PIPAC as a promising treatment for peritoneal metastasis, optimizing nebulizer technology to enhance treatment outcomes has garnered significant research interest. Content Following initial investigations into the internal structure, mechanical properties, and optimization parameters of the original PIPAC nebulizer, researchers worldwide have focused on refining nebulizer design and exploring innovative applications of aerosolization devices, resulting in the development of several clinically applicable nebulizers with distinct characteristics. Summary This review aims to provide a comprehensive examination of the global advancements in PIPAC nebulizer development, the nebulizer alternative devices, evaluation parameters and methods, as well as future research directions, aiming to inform the development, optimization, and application of novel nebulizers for PIPAC, thereby contributing to the advancement of this promising therapeutic approach. Outlook Current methods for evaluating nebulizer performance are continually being refined, and the integration of nebulizers with other physical modalities holds great promise for further improving PIPAC outcomes.
Objectives:Complicated pleural infections present significant challenges. Predominant causative microorganisms include the Streptococcus anginosus group (SAG) and Klebsiella pneumoniae (KP). However, limited data are available on the risk factors and outcomes associated with SAG-related pleural infection compared to KP-related pleural infection. Methods:This retrospective study was conducted in patients who underwent pleural drainage due to complicated pleural infection at Kyungpook National University Hospital in South Korea between January 2011 and December 2023. Clinical characteristics, drug resistance profiles, and outcomes were compared between patients with SAG-related and KP-related pleural infections. Results:A total of 432 patients were assessed. Among them, 161 (37 %) had positive pleural fluid cultures, with SAG (n=68, 42 %) and KP (n=34, 21 %) being the predominant pathogens. Thus, 102 patients with complicated pleural infection caused by SAG or KP were analyzed. SAG cases were associated with higher rates of chronic neurologic disease, lower rates of diabetes mellitus, prolonged symptom duration, elevated white blood cell counts, and positive gram stains on pleural fluid compared to KP cases. There were no significant differences observed between the two groups regarding radiological findings. SAG strains showed resistance rates exceeding 20 % to penicillin, erythromycin, tetracycline, and clindamycin, while remaining largely susceptible to commonly used third-generation cephalosporins, ampicillin, and fluoroquinolones. The in-hospital mortality rates were approximately 10 %, consistent across both groups. Conclusions:SAG-related pleural infections showed distinct clinical features, including more frequent chronic neurologic disease, but in-hospital mortality was comparable to that of KP-related infections.
Objectives:Peritoneal regression grade score (PRGS) has emerged a scoring system designed to measure the extent of residual disease following systemic or intraperitoneal therapies in patients with carcinomatosis. Higher (3-4) PRG-Scores match with a mediocre treatment response and prognosis. Conversely, lower grades (1-2) response are linked to significantly longer overall and progression-free survival periods. This study explores the utility of PRGS in assessing prognosis and optimizing therapeutic strategies for patients with peritoneal metastasis secondary to gastric malignancy. Methods:This is a prospective cohort study, including patients with gastric cancer and peritoneal metastasis undergoing chemotherapy with intent for subsequent cytoreductive surgery. The primary endpoint of the study is to assess the pathological response of peritoneal involvement to primary chemotherapy according to the PRGS. Secondary objectives are to correlate PRGS with some clinical, pathological and molecular features (MMR, PDL1, CPS, HER2) as well as with other clinical and biochemical markers related to chemotherapy response. Results:This protocol summarizes the current scientific evidence regarding the effectiveness of the PRGS in assessing peritoneal response to targeted therapies. It further hypothesizes its potential utility in evaluating the effects of systemic therapies for gastric cancer with peritoneal metastases, while also defining inclusion and exclusion criteria and outlining a flowchart for its implementation. Conclusions:Our final endpoint is to expand PRGS applications to curative settings and identify factors such as tumor biology and chemotherapy regimens that may guide patient selection for adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) in gastric cancer with peritoneal metastasis.
Objectives Non-mucinous appendiceal neoplasms (NMAN) are rare. The role of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in treating peritoneal dissemination from NMAN is poorly defined. We hypothesise that histology impacts survival and compared the disease characteristics and short- and long-term outcomes of mucinous and non-mucinous appendiceal neoplasms treated with CRS/HIPEC. Methods We retrospectively reviewed a prospective database of 228 patients with peritoneal disease from appendiceal primaries proceeding to CRS/HIPEC from 01/01/2008 to 30/06/2022 at a tertiary referral centre in New Zealand. Results There were 209 mucinous appendiceal neoplasms (MANs) and 19 NMANs. NMANs were more likely to metastasise to lymph nodes (p<0.001) and be treated with systemic chemotherapy (p<0.001) than MANs. Surgery for NMAN was more likely to involve small bowel resection (p<0.001) and less likely to achieve complete cytoreduction (p<0.001). Short-term outcomes were similar between MAN and NMAN. CRS/HIPEC for NMAN had a major complication rate of 15.3 % and no perioperative mortality. Extraperitoneal recurrence, including pleural and systemic recurrence, was more likely to occur in NMAN than all grades of MAN. The median overall survival was not reached in MAN and 16.0 months in NMAN. High PCI, ECOG, and tumour grade were associated with poor survival in NMAN. Conclusions The prognosis following CRS/HIPEC for NMAN is poor. Patients with NMAN need to be judiciously selected for CRS/HIPEC.
Objectives:Cytoreductive surgery with heated intraperitoneal chemotherapy (CRS/HIPEC) requiring diaphragmatic stripping or resection may predispose to pleuropulmonary recurrence. This review was to assess the rates of pleuropulmonary recurrence after CRS/HIPEC for patients who had high-grade appendiceal neoplasm and meosthelioma. Methods:A retrospective review (September 1996-November 2021) at a single tertiary center identified 716 patients who underwent CRS/HIPEC with diaphragmatic intervention; 203 had high-grade appendiceal neoplasms and 63 had mesothelioma. Radiologic or pathologic evidence of pleuropulmonary recurrence was recorded. Time from CRS/HIPEC to chest recurrence was analyzed using Kaplan-Meier methods. Results:Twenty patients (12 appendiceal; 8 mesothelioma) developed pleuropulmonary recurrence. In the appendiceal cohort (mean age 51.5 years; median PCI 30), all 12 underwent bilateral diaphragm intervention (four with full-thickness resection) with CCR 0-1. Time to chest recurrence ranged from 0.3 to 82.8 months; half experienced early respiratory complications (e.g., pleural effusion, pneumothorax). In the mesothelioma cohort (mean age 44.9 years; median PCI 22.1), seven had bilateral stripping (two with resection) and one had unilateral stripping; CCR was 0-1. Recurrence occurred between 8.0 and 85.4 months (median ∼31.4 months); half had early respiratory compromise. No significant associations were observed between PCI, CCR, or extent of diaphragmatic intervention and recurrence risk, although ICU stay and CCR weakly correlated with recurrence in mesothelioma. Conclusions:Pleuropulmonary recurrence following CRS/HIPEC with diaphragm intervention is rare (2.7 %), with early recurrences suggesting occult thoracic involvement. Bilateral diaphragm manipulation was common among those with recurrence.
Objectives In 2020, Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) reached stage 2b of the IDEAL framework and a prospective international PIPAC database was launched in June 2020 by the International Society for the Study of the Pleura and Peritoneum (ISSPP). The ISSPP PIPAC database consists of six key elements, which are reported in an annual report. The ISSPP Registry Group decided to investigate data completeness within the ISSPP PIPAC Database. Methods Retrospective analysis of data completeness in the six key elements was performed between October 1st and 14th, 2024. This was complemented by an in-depth analysis of missing data in Response Evaluation, Complications, and Follow-up . Results Thirty centers, 950 patients, and 2777 PIPAC procedures were registered in the ISSPP database by October 2024. Sixteen of the 30 centers had included patients. Incomplete data were observed in four of the six key elements. Most centers (7/16) had incomplete data in Complications , followed by Response evaluation (5/16), and Follow-up (2/16). In depth analysis showed that, e.g., for complications, the date and type of the complication was registered in 88 and 89 %, respectively. Incomplete data in Response evaluation occurred mainly in the small group of patients evaluated by nonperitoneal regression grading score (non-PRGS, n=316), where no scoring was provided in 211 patients (72 %). Follow-up data, such as date of death or reasons for stopping PIPAC, were provided for 86 and 85 % of patients. Conclusions Overall data completeness of the ISSPP PIPAC Database was considered satisfactory at the present state, and the ISSPP Registry Group has launched several initiatives to further improve data completeness and quality, to provide solid data sets for future annual reports and other research.
Objectives:In 2020, the International Society for the Study of the Pleura and Peritoneum (ISSPP) launched a database monitoring real-world data on Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC)-directed therapy in patients with peritoneal metastases (PM). This study covers data from the third annual report on the ISSPP PIPAC database. Methods:Systematic analysis of all data reported to the ISSPP PIPAC database between June 15th, 2020, and November 1st, 2024. We hypothesize that ISSPP PIPAC data align with existing literature. Results:Seventeen PIPAC centers reported 3224 PIPAC treatments in 1126 patients with PM (median number of treatments 2, range 1-33). The median peritoneal cancer index (PCI) at PIPAC 1 was 19 and remained unchanged during subsequent treatments. The number of patients with >500 mL ascites significantly decreased from the first three PIPAC treatments to PIPAC 4+ (p<0.01). Major complications (Dindo-Clavien ≥3b) occurred in 0.7 % of the treatments, while Common. Terminology Criteria for Adverse Events (CTCAE) grades ≥3 were reported in 5.2 %. Peritoneal regression grading score (PRGS) was performed in 2306 (72 %) of the treatments. At PIPAC 1, 2, and 3, complete or major response (mean PRGS ≤2) was achieved in 57 %, 72 %, and 75 % of the patients, respectively. Median overall survival from PIPAC 1 was 12.5 months. Patients with complete/major response (mean PRGS ≤2) at PIPAC 1-3 had a longer overall survival compared to patients with minimal/no response (mean PRGS >2). Conclusions:This study from the ISSPP PIPAC database provides substantial real-world data demonstrating the feasibility, safety, and potential effect of PIPAC-directed therapy in patients with PM.
