Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) Treatment at Asklepios Hospital Barmbek

When peritoneal cancer reaches a stage where traditional surgery or even HIPEC is no longer feasible, the Asklepios Hospital Barmbek in Hamburg offers a sophisticated, minimally invasive alternative: pressurized intraperitoneal aerosol chemotherapy (PIPAC). This innovative approach represents a paradigm shift in how we deliver medication to the abdominal cavity. Instead of a liquid bath, PIPAC transforms chemotherapy into a fine, pressurized mist. This allows our specialists to treat patients who may be too frail for major surgery or whose disease has become resistant to standard systemic treatments, providing a vital bridge toward stabilization and improved quality of life. The mechanics of PIPAC at Barmbek utilize the physical principles of gas pressure to overcome the natural barriers of a tumor. During a laparoscopic "keyhole" procedure, our surgeons insert a specialized nebulizer, known as the CapnoPen, into the abdomen. This device atomizes the liquid chemotherapy into a therapeutic aerosol. Under the pressure of the CO2 gas used during laparoscopy, the tiny droplets are forced deep into the tumor tissue and into the furthest recesses of the peritoneal cavity, areas that liquid chemotherapy often fails to reach. This "pressure-cooker" effect ensures a more uniform distribution and deeper drug penetration, allowing us to use significantly lower doses while achieving a more potent local effect. A defining characteristic of the PIPAC program at Asklepios Barmbek is its repeatability and patient tolerance. Because the procedure is performed via two tiny incisions and the systemic absorption of the chemotherapy is extremely low, the typical side effects like hair loss, severe nausea, or kidney damage are almost entirely avoided. Most patients undergo a cycle of three treatments, spaced approximately six to eight weeks apart. This interval allows our medical team to objectively monitor the tumor's response. Between cycles, we perform a "peritoneal biopsy" and take high-resolution images to map the regression of the disease, providing a data-driven view of the therapy’s success. The clinical workflow at Barmbek is designed for rapid recovery. A typical PIPAC session requires only a two to three-day hospital stay. Patients generally return to their normal diet and activity levels within forty-eight hours, making it an ideal option for maintaining a high quality of life during active cancer treatment. For many of our patients, PIPAC serves as a "neoadjuvant" tool, meaning it shrinks the tumor load so effectively that a patient who was previously considered inoperable may eventually become a candidate for a curative surgical resection or HIPEC.