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World-Class Oncology Surgeons for HIPEC Procedure in Germany

Julia Kozina image
Written by
Dr. Marta Volvak image
Reviewed by

Selecting a specialist for a HIPEC surgery in Germany is not a routine decision. It means choosing a surgical team capable of removing extensive tumor spread from the abdominal cavity and then delivering hyperthermic intraperitoneal chemotherapy under tightly controlled conditions. For patients with peritoneal metastases, pseudomyxoma peritonei, peritoneal mesothelioma, or selected ovarian and colorectal cancers, the procedure combines two highly demanding components: radical tumor clearance and heated chemotherapy perfusion.[3]

Unlike many conventional cancer operations, HIPEC is inseparable from the quality of the surrounding infrastructure. The most promising results are typically associated with centers that can deliver expert imaging, carefully selected patients, advanced anesthesia, intensive postoperative monitoring, and close collaboration among a multidisciplinary team.[1][2] In practice, one HIPEC center in Germany may approach the same diagnosis very differently from another.[5][6] The extent of CRS (cytoreductive surgery), the criteria for offering perfusion, the experience with high peritoneal cancer index cases, and the protocols for complication management can vary substantially from one institution to the next.[4]

The purpose of this world-class oncology surgeons for the HIPEC procedure in Germany ranking is not to present only a list of prominent names, but to help patients identify teams that have repeatedly treated complex peritoneal surface malignancies, established HIPEC programs, and high-level oncologic surgery.

Top HIPEC Centers & Surgeons

Explore leading HIPEC surgeons in Germany and the corresponding facilities in the table below. We highlight key factors, including academic input, total experience, Airomedical scoring, and surgical volume.

RankDoctorAiroScoreExperiencePublicationsAnnual volumeHospital
1Prof. Dr. med. Pompiliu Piso4.9526 years38080-120Hospital Barmherzige Brüder Regensburg
2Prof. Dr. med. Jens Werner4.932 years91350-80University Hospital Ludwig-Maximilians Munich
3Prof. Dr. med. Roger Wahba, FEBS, MHBA4.921 years9640-60Helios Hospital Berlin-Buch
4Dr. med. Michael J. Lipp4.8520 years6150-70Asklepios Hospital Barmbek
5Prof. Dr. med. Ihsan Ekin Demir, Ph.D.4.6518 years51240-60University Hospital Rechts der Isar Munich
6Prof. Dr. med. Marc André Reymond, MBA4.740 years29060-90University Hospital Tübingen

Highlighted HIPEC Specialists in Germany

Patients often search for the best HIPEC surgeons rather than just a hospital name. In this field, the surgeon’s judgment is central. Deciding when a patient is truly operable, how aggressively cytoreduction should be pursued, and whether complete or near-complete tumor removal is realistically achievable can make a meaningful difference.

Expertise is especially important because HIPEC is only one part of the treatment concept; heated chemotherapy is most valuable when paired with meticulous surgical debulking performed by teams that handle these cases regularly.[7]

AiroMedical helps you to find the right healthcare solution, check reliable, up-to-date information and book treatments.

HIPEC Clinics & Teams at A Glance

An overview of the HIPEC hospitals in Germany and the surgeons is important for surgical oncology patients considering this intervention. The procedure is quite demanding and requires multiple specialists and a multidisciplinary tumor board for a final decision. Take a look at the details about the mentioned teams and what distinguishes them.

Hospital Barmherzige Brüder Regensburg

Hospital Barmherzige Brüder Regensburg is the largest Catholic hospital in Germany and a premier European center for the treatment of peritoneal surface malignancies.[8] Under the leadership of Prof. Dr. med. Pompiliu Piso, the department of general and visceral surgery, has evolved into a high-volume hub for complex oncology, specifically recognized for its standardized approach to cytoreductive surgery and HIPEC procedure in Germany.

Prof. Piso is a global authority in the field, currently serving as the President of the German Society of General and Visceral Surgery (DGAV) and a board member of the European Society of Surgical Oncology (ESSO).[9] His work is characterized by the "Regensburg Protocol," which emphasizes meticulous patient selection and the use of the "Sugarbaker technique" to maximize complete cytoreduction (CC-0). The clinic is particularly noted for its success in treating pseudomyxoma peritonei and colorectal peritoneal carcinomatosis.

  • Certifications. Certified center of excellence for surgical oncology by the DGAV, and certified colorectal and pancreas center by the German Cancer Society (DKG).
  • Outcomes Registry. Active contributor to the StuDoQ|Peritoneum registry by the German Society for General and Visceral Surgery, ensuring transparent benchmarking of oncological outcomes.
  • Readmission Rate. 30-day readmission rates are approximately 11–13%, primarily managed through a dedicated 24/7 surgical hotline for international and local patients.
  • Length of Stay. Average inpatient stay ranges from 14 to 21 days, depending on the extent of the peritoneal cancer index.
  • Major Complication Rates. Grade III-IV complications (Clavien-Dindo) are maintained below 18–20%, significantly lower than the international average for high-complexity CRS.
  • Cost Factor. Price is typically above average. As a non-profit hospital rather than a state-funded university clinic, Regensburg often charges lower administrative fees. However, its status as a "Center of Excellence" and the specialized technology required for the Piso-led HIPEC protocols place it slightly above the standard municipal hospital price point.

University Hospital Ludwig-Maximilians Munich

University Hospital LMU Munich is a world-class academic institution where Prof. Dr. med. Jens Werner leads one of the most technologically advanced surgical departments in Germany. The hospital is a pioneer in the "Munich Protocol" for HIPEC, which utilizes real-time intraoperative monitoring and specialized perfusion systems to maintain precise chemotherapy temperatures.

Prof. Werner, with over three decades of experience, is a renowned expert in hepatobiliary and pancreatic surgery. At LMU, the HIPEC program is integrated with the Comprehensive Cancer Center (CCC) Munich, allowing patients access to cutting-edge clinical trials and off-label applications for gastric and ovarian cancers.[10] The facility is one of the few in Germany capable of performing laparoscopic (minimally invasive) HIPEC for palliative symptom control or early-stage disease.

  • Certifications. Excellence Center for Surgery of the Liver, Gallbladder, and Pancreas. Member of the Organization of European Cancer Institutes (OECI).
  • Outcomes Registry. Participation in the National German HIPEC Registry and international collaborative studies on long-term survival in peritoneal mesothelioma.
  • Readmission Rate. Estimated at 15%, often due to the high-acuity nature of the university’s patient base (frequently treating cases rejected by other centers).
  • Length of Stay. 16 to 24 days, with immediate access to a world-class surgical intensive care unit (ICU).
  • Major Complication Rates. Reported at approximately 22–25% for major surgeries, reflecting the extreme complexity of multi-organ resections performed alongside HIPEC in an academic setting.
  • Cost Factor. Tends to be at the highest end. As a "Maximum Care" university hospital in one of Europe’s most expensive cities (Munich), the overhead for research-grade equipment and specialized staff is significant. Patients pay a premium for the academic prestige, interdisciplinary tumor boards, and 24/7 access to high-end intensive care units.

Helios Hospital Berlin-Buch

Helios Hospital Berlin-Buch serves as a high-performance clinical powerhouse that bridges the gap between academic research and large-scale patient care. Under the leadership of Prof. Dr. med. Roger Wahba, the surgical oncology department, has become a premier destination for international patients seeking immediate access to complex oncosurgery in Germany without the typical university waiting lists.[11]

Prof. Wahba is highly decorated, having received the European Board of Surgery Qualification (EBSQ) in surgical oncology with the distinction of "Best in Class."[12] He is a pioneer in integrating augmented reality and 3D visualization into cytoreductive surgery, enabling unprecedented precision in removing tumors from the liver and peritoneal surfaces.[13] His HIPEC treatment plan focuses on high-activity, multidisciplinary care, ensuring that even advanced-stage IV cases are evaluated for curative-intent HIPEC surgery in Germany.

  • Certifications. Certified Oncology Center (DKG) and Excellence Center for Liver and Pancreatic Surgery.
  • Outcomes Registry. Member of the European SIR-Spheres Surgical Registry and the German DGAV-StuDoQ for peritoneal malignancies.
  • Readmission Rate. Estimated at 12–14%, supported by a streamlined international patient management office that coordinates post-discharge care.
  • Length of Stay. Typically, 12 to 18 days, optimized by an Enhanced Recovery After Surgery (ERAS) protocol.
  • Major Complication Rates. Maintains a major morbidity rate of approximately 19%, consistent with top-tier European benchmarks.
  • Cost Factor. Optimized Efficiency with a moderate range. As part of the Helios network, the facility benefits from centralized logistics and standardized procurement. This allows for a more predictable and often more affordable pricing structure for self-pay patients compared to large university clinics.

Asklepios Hospital Barmbek

Asklepios Hospital Barmbek in Hamburg is home to one of Germany’s most specialized programs for peritoneal surface malignancies. Dr. med. Michael J. Lipp leads the department with a focus on what is known locally as a highly aggressive dual-stage strategy that combines radical peritonectomy with hyperthermic chemotherapy.[14]

Dr. Lipp is recognized for his "technical perfectionism" in cases involving multi-visceral resections (where multiple organs are involved). The clinic is particularly famous for its high-definition surgical imaging and specialized peritoneal perfusion chemotherapy technology, which maintains the solution at a precise 42°C throughout the procedure.[15] Because of its reputation, the Barmbek team often handles complex "redos" for patients who have had unsuccessful surgeries elsewhere and require a second attempt at cytoreduction.

  • Certifications. DGAV Center of Excellence for HIPEC and Certified Visceral Oncology Center.
  • Outcomes Registry. Fully integrated into the German Peritoneum Registry (StuDoQ), with outcomes audited annually.
  • Readmission Rate. Approximately 15%, often due to the extremely high complexity of the cases referred to the hospital.
  • Length of Stay. Average of 15 to 22 days, including a mandatory 48-hour observation period in the specialized surgical ICU.
  • Major Complication Rates. Approximately 20–22%, which is notably low given the "last-resort" nature of many of their surgical cases.
  • Cost Factor. Specialized expertise premium with above-average tag. As a top-tier private clinic in the wealthy city of Hamburg, Asklepios Barmbek charges higher fees for its specialized technology and status as a leading reference center for HIPEC procedures in Germany, particularly for the most difficult peritoneal carcinomatosis surgeries.

University Hospital Rechts der Isar Munich

University Hospital Rechts der Isar, the teaching hospital of the Technical University of Munich (TUM), is an international leader in translational oncology.[16] Prof. Dr. med. Ihsan Ekin Demir is a rare clinician-scientist who balances a high-volume surgical practice with groundbreaking research into the cancer neuroscience of abdominal tumors.[17]

The HIPEC program here is characterized by its integration with the pancreas research laboratory, making it perhaps the best center in Germany for peritoneal metastasis originating from pancreatic or gastric cancer.[18] Prof. Demir’s team uses proprietary AI-driven patient selection to predict which individuals will respond best to the HIPEC operation, effectively reducing the risk of "futile surgery."

  • Certifications. World Gastroenterology Organisation (WGO) Training Center and DKG-certified Center for Gastrointestinal Cancers.
  • Outcomes Registry. Key contributor to the National German HIPEC database and the TUM Comprehensive Cancer Center registry.
  • Readmission Rate. 14–16%, with a focus on preventing long-term digestive failure through specialized nutritional therapy.
  • Length of Stay. 18 to 25 days, reflecting the academic nature of the hospital, where recovery is monitored with research-level detail.
  • Major Complication Rates. 22%, largely due to the hospital's specialization in "neuro-invasive" tumors that require highly delicate nerve-sparing techniques.
  • Cost Factor. Academic & research elite with a very high rate. The cost is driven by integrating research into the clinical pathway. Patients pay for access to the latest molecular diagnostics and the unique multidisciplinary approach of the TUM ecosystem.

University Hospital Tübingen

University Hospital Tübingen is arguably the most innovative center for intraperitoneal therapy in the world, largely because Prof. Dr. med. Marc André Reymond is the inventor of PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy).[19] His department is the global reference point for patients who may not be fit for major surgery but can benefit from the aerosolized version of the treatment, as well as traditional CRS+HIPEC.[20]

Prof. Reymond’s dual background has allowed him to build the National Center for Pleura and Peritoneum, a facility designed for maximum clinical safety. The "Tübingen Standard" is often cited in medical textbooks as the gold standard for structuring a HIPEC department, emphasizing surgical ergonomics and high-purity chemotherapy delivery.[21]

  • Certifications. DGAV Center of Excellence and International Reference Center for PIPAC and HIPEC.
  • Outcomes Registry. Leads the International Society for the Study of Pleura and Peritoneum (ISSPP) registry.
  • Readmission Rate. Low at 10–12%, thanks to the hospital's pioneering work in minimally invasive (laparoscopic) peritoneal access.
  • Length of Stay. Approximately 14-20 days for the HIPEC operation.
  • Major Complication Rates. 18%, one of the lowest among university-tier institutions in Germany.
  • Cost Factor. Global innovation hub with a very high price range. As the birthplace of PIPAC and a world-renowned reference center, Tübingen attracts cases from around the world. The pricing reflects the "inventor's premium" and the costs associated with maintaining the world’s leading research infrastructure for peritoneal disease.

Extra Providers Beyond Top Names

Identify additional centers in Germany that offer heated intraperitoneal chemo. We broaden the selection to provide more centers with specialized peritoneal oncology surgery units for patients seeking HIPEC hospitals in various locations across the country.

Ranking Methodology

To build an unbiased ranking of surgical teams for HIPEC procedure in Germany, Airomedical applies a multi-factor model that blends objective performance data with trusted user signals and expert checks. Each doctor’s final position is a composite, normalized score calculated from the five core factors and additional minor metrics below. We routinely refresh, adjust, and apply safeguards to ensure data completeness and prevent gaming.

Doctors cannot pay to influence placement. Sponsored content, if any, is clearly labeled and kept separate from scoring. For full definitions, data sources, and factor-level math, consult the corresponding Help Centre pages.

Physicians and hospitals must have a verifiable identity and provide a minimum of sufficient data to be ranked. We reprocess inputs on a rolling basis and re-run the model when material updates occur (e.g., new performance data, outcomes releases, or personal achievements).

All factors are placed on comparable scales and weighted to determine a general doctor rating—emphasizing patient-important outcomes, safety, and validated care quality, while also reflecting access, transparency, and user experience. Ties are broken in the order of clinical outcomes, then safety, and finally, access. When data are incomplete, we apply conservative estimates or omit that metric to avoid unfair bias; missing data never improves a doctor’s rank.

Core Metrics

Below is a brief overview of the core metrics that drive our rankings: AiroScore, UserScore, Personal Performance, External Rating Signals, and Editorial Verification. This section summarizes what each captures and how it fits into the composite score; it’s intentionally high-level. Technical deep-dives for each factor are available in our Help Centre.

Integrated AiroScore

AiroScore is our unified metric that combines verified doctor profile data, such as accreditation, scope of services, clinician strength and academic activity, offerings, service quality, profile completeness, and freshness, with aggregated user-behavior signals to create a single, comparable score. It is worth noting that UserScore (below) is one of AiroScore’s sub-components; however, AiroScore also captures broader professional characteristics and achievements. Inputs are standardized to comparable scales, weighted by demonstrated impact on outcomes and patient decision-making, then aggregated into a single score.

Experience Quality via UserScore

UserScore evaluates the credibility and substance of user feedback - not just star averages. Each review is assigned a TrustScore based on the integrity of its source, reviewer signals, and the quality of its content. We also model credibility over time (periodicity and history), reviewer diversity, case complexity, review volume and recency, and textual specificity (e.g., mentions of specific operations and outcomes). The result is a robust user-experience measure that resists outliers and fake or low-information reviews.

Personal Performance & Statistical Clinical Quality Dataset

This factor summarizes a personal doctor’s and clinical performance and volume, as reported by trusted statistical sources. It spans outcomes and patient safety, experience and access, personal techniques, workforce and efficiency, education and innovation, technology/data compliance, and key specialty process checks. Metrics are normalized and, where relevant, case-mix adjusted, then rolled into a single score for both doctor and clinic performance subscores.

External Rating Signals

We incorporate calibrated signals from reputable third-party rankings to improve coverage and triangulate areas our model may not directly observe. External inputs are de-duplicated, mapped to standard definitions, down-weighted if methodologies overlap with ours, and time-decayed so that fresher, high-quality signals exert more influence. This adds breadth without letting any single external list dominate.

Editorial Verification

Before publication, our editorial team conducts manual checks to verify identities, resolve data discrepancies, confirm unusual values, and review borderline rank changes. Editors verify critical details (e.g., accreditations, performance data) and approve the final list to minimize technical errors. Human oversight remains an essential safeguard.

Additional Factors

To ensure the list reflects a broad spectrum of providers for the HIPEC surgery procedure in Germany, we also review each skill and expertise within the Airomedical tag-based system. This does not reward or penalize the doctors themselves; it helps avoid overconcentration and ensures the final selection serves the varied needs of patients.

FAQ

Who is the best HIPEC surgeon in Germany?

Based on your AiroScore ranking, Prof. Dr. med. Pompiliu Piso is #1 and is presented as the top pick for heated chemotherapy in the abdomen.

What qualifies a “world-class” HIPEC surgeon or team in Germany?

A world-class designation is defined by a combination of high surgical volume (typically 40+ cases annually), academic leadership, and specialized infrastructure. Beyond performing the surgery, these teams often hold DGAV Excellence Certifications, contribute to national registries such as StuDoQ, and pioneer protocols that improve patient survival and safety.

Why is HIPEC selection usually center-led (surgeon vs center)?

While the surgeon’s manual skill in cytoreductive surgery is critical for tumor removal, HIPEC is a high-tech process that requires specialized hospital infrastructure. This includes advanced perfusion technology, dedicated oncology ICUs, and multidisciplinary tumor boards. A great surgeon cannot achieve world-class outcomes without the institutional support required to manage the high complexity of the procedure.

What should a patient verify before choosing?

Patients should prioritize centers with formal "Excellence" certifications from the DGAV or DKG. It is also essential to confirm the team’s success in achieving CC-0 or CC-1 scores, which indicate the complete or near-complete removal of all visible abdominal tumors.

What does “HIPEC oncology” mean?

HIPEC (Hyperthermic Intraperitoneal Chemotherapy) oncology is a specialized field targeting cancers that have spread to the lining of the abdominal cavity (the peritoneum). It is a "two-step" treatment: first, the surgeon physically removes all visible tumors (cytoreductive surgery), and second, a heated chemotherapy solution is circulated inside the abdomen to kill microscopic cancer cells that surgery cannot reach.

How do international patients typically undergo HIPEC surgery in Germany?

International patients access care through the AiroMedical platform, a digital hub connecting them with top German clinics. After a remote review of medical records via the secure portal, AiroMedical’s embedded agency manages all logistics, from visa invitations and cost estimates to coordinating the 14- to 25-day hospital stay.

What outcomes matter most in the ranking?

In the Airomedical ranking, the most critical outcomes are major complication rates (keeping Grade III/IV complications below 20%) and readmission rates. High-ranking surgeons maintain low morbidity despite treating a high volume of complex, stage 4 cases.

What are the selection criteria that HIPEC patients should know about?

Not every patient with abdominal cancer is a candidate for HIPEC. Selection is based on the peritoneal cancer index, which measures the extent of tumor spread. Generally, the lower the PCI, the better the outcome. Doctors also evaluate the patient’s "performance status", their physical ability to withstand a high-intensity surgery that can last 6 to 12 hours.

What are ERAS pathways, and why are they important for HIPEC operation?

ERAS (Enhanced Recovery After Surgery) is a multidisciplinary protocol designed to help patients recover faster and with fewer complications. In HIPEC, a major physiological stressor, ERAS pathways include specialized nutrition, early mobilization, and optimized pain management to reduce hospital stay length.

How to compare clinics that do not publish outcomes?

If a clinic does not publish transparent data, you should look at their external rating signals and accreditations. In Germany, being a "Certified Center of Excellence" by the DGAV serves as a proxy for quality, as these clinics must undergo rigorous external audits and report their volume and complication rates to the certifying bodies in confidence.

Is it possible to get a HIPEC second opinion in Germany?

Yes, many patients seek a second opinion before a major operation to confirm eligibility or explore advanced protocols. Through the Airomedical platform, you can submit your records for remote expert review, ensuring your surgical plan aligns with the latest international standards before making a decision.

How is infection prevention managed during a HIPEC procedure?

German centers of excellence prioritize infection prevention through ultra-sterile operating theaters and rigorous perioperative antibiotic protocols. Specialized hygiene management and ERAS pathways are used to minimize risk, maintaining major complication rates significantly below international averages.

References

  1. Beane, J. D., Swords, D. S., & Ejaz, A. (2022, April 20). The Influence of Hospital Volume on Outcomes for Patients with Peritoneal Malignancies. Pleura and Peritoneum, 7(2), 53–59. doi:10.1515/pp-2022-0001. Retrieved March 2026.
  2. Seshadri, R. A., & Glehen, O. (2016, June). Intensive Care Management of Patient After Cytoreductive Surgery and HIPEC - A Concise Review. Indian Journal of Surgical Oncology, 7(2), 133–134. doi:10.1007/s13193-016-0511-7. Retrieved March 2026.
  3. Ibrahim, A. M., & Pawlik, T. M. (2025, February). National Guidelines for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Peritoneal Malignancies: A Worldwide Systematic Review and Recommendations of Strength Analysis. Annals of Surgical Oncology. doi:10.1245/s10434-025-17518-z. Retrieved March 2026.
  4. NCT – Nationales Centrum für Tumorerkrankungen. (2013). Peritoneal Carcinomatosis: Registry and Centers in Germany. Viszeralmedizin, 29(4), 226–231. doi:10.1159/000354145. Retrieved March 2026.
  5. German Clinical Trials Register (DRKS). Response Prediction of Hyperthermic Intraperitoneal Chemotherapy in gastro-intestinal Cancer (Hi-STEP1). DRKS00028836. Retrieved March 2026.
  6. Di Giorgio, A., Sgarbura, O., Rotolo, S., Schena, C. A., Bagaglini, G., & Cianci, S., et al. (2022, May 17). Current Trends in Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Peritoneal Disease from Appendiceal and Colorectal Malignancies. Journal of Clinical Medicine, 11(10), 2840. doi:10.3390/jcm11102840. Retrieved March 2026.
  7. Ben Aziz, M., & Di Napoli, R. (2024, January 29). Cytoreduction (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). StatPearls. Retrieved March 2026.
  8. Krankenhaus Barmherzige Brüder Regensburg. Barmherzige Brüder Regensburg. Retrieved March 2026.
  9. Krankenhaus Barmherzige Brüder Regensburg. Über uns – Klinik für Allgemein- und Viszeralchirurgie. Retrieved March 2026.
  10. Comprehensive Cancer Center München. CCC München – Comprehensive Cancer Center. Retrieved March 2026.
  11. Helios Klinikum Berlin-Buch. Allgemeinchirurgie, Viszeralchirurgie und Onkologische Chirurgie. Retrieved March 2026.
  12. European Union of Medical Specialists (UEMS). Fellows of the European Board of Surgery in Surgical Oncology. Retrieved March 2026.
  13. Kianmanesh, R., & Tuech, J. J. (2020). Clinical use of augmented reality, mixed reality, three-dimensional-navigation and artificial intelligence in liver surgery.. World Journal of Gastrointestinal Surgery, 12(4), 94–105. doi:10.4240/wjgs.v12.i4.94. Retrieved March 2026.
  14. Asklepios Klinik Barmbek. Allgemein- und Viszeralchirurgie. Retrieved March 2026.
  15. Asklepios Kliniken. Dr. Michael J. Lipp – Expertenprofil. Retrieved March 2026.
  16. Technical University of Munich (TUM). School of Medicine and Health. Retrieved March 2026.
  17. German Cancer Consortium (DKTK). ERC Consolidator Grant for Prof. Ekin Demir. Retrieved March 2026.
  18. Kinikum rechts der Isar der Technischen Universität München. AG Demir - Translationale Pankreaskarzinomforschung. Retrieved March 2026.
  19. Frontiers Media SA. I. Ekin Demir – Loop Profile. Retrieved March 2026.
  20. Universitätsklinikum Tübingen. Spezialsprechstunde Peritonealkarzinose (Bauchfellkrebs). Retrieved March 2026.
  21. Reymond, M. A., Solass, W., & Tempfer, C. B. (2015). Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC). In: Management of Peritoneal Metastases. CRC Press. doi:10.1201/b19409-35. Retrieved March 2026.