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Pressurised intraperitoneal aerosol chemotherapy for peritoneal carcinomatosis

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The condition, current treatments and procedure

The condition

1.3 Peritoneal metastases commonly result from the regional spread of gastrointestinal, gynaecological and other malignancies. Peritoneal carcinomatosis is an advanced form of cancer associated with short survival and poor quality of life. It may lead to bowel obstruction, fluid build-up in the peritoneal cavity and pain.

Current treatments

1.4 There is no curative treatment. Current standard treatment uses systemic chemotherapy or surgery for short-term palliation of complications such as bowel obstruction.

The procedure

1.5 Pressurised intraperitoneal aerosol chemotherapy for peritoneal carcinomatosis is a laparoscopic procedure usually done under general anaesthesia. The aim is to distribute the drug uniformly to all surfaces of the abdomen and pelvis.

1.6 Trocars are inserted and the abdomen insufflated with carbon dioxide. Peritoneal biopsies or local partial peritonectomy may be done at this time. The chemotherapy is delivered using an aerosol device containing normothermic chemotherapy solution. This device is connected to a high-pressure injector, which is inserted into the abdomen through an access port. For operator safety, the procedure takes place in an operating room with laminar air flow. Once in position, the device is operated remotely. A laparoscopic camera can be used to visualise the treatment. The chemotherapy is kept in the insufflated peritoneum for about 30 minutes. The chemotherapy aerosol is then exsufflated via a closed extraction system. Trocars are removed and laparoscopy completed. The procedure is usually repeated several weeks later. One standard course of treatment comprises 3 procedures, usually given 6 weeks apart, although the timing can vary.