1. Laparoscopic access
Two or three small incisions (5 to 12 mm) are made to introduce the camera and nebulizer device into the abdominal cavity.
Reviewed by Dr. Juan José Torrent, ISSPP-accredited PIPAC trainer · Updated: October 27, 2026
PIPAC: Pressurized Intraperitoneal Aerosol Chemotherapy
Laparoscopic procedureA minimally invasive technique that delivers chemotherapy as a pressurized aerosol directly into the abdominal cavity to treat peritoneal carcinomatosis.
Contact a specialistWhat is PIPAC?
PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy) is a technique that delivers chemotherapy as a pressurized aerosol directly into the abdominal cavity. It is performed via laparoscopy, making it a minimally invasive procedure.
Unlike HIPEC, PIPAC can be performed repeatedly and is especially indicated for patients with extensive peritoneal carcinomatosis who are not candidates for complete cytoreductive surgery, or as neoadjuvant treatment to reduce tumor burden.
How is the PIPAC procedure performed?
PIPAC is performed in the operating room under general anesthesia using laparoscopic technique. The whole procedure takes between 45 and 90 minutes.
2. Exploration and biopsy
Visual evaluation of the abdominal cavity, documentation of tumor extent, and biopsies for histological analysis.
3. Drug nebulization
Chemotherapy is nebulized at high pressure (12 mmHg) creating an aerosol that distributes evenly across the entire peritoneal surface.
4. Exposure time
The aerosol remains in contact with the peritoneum for 30 minutes, after which it is safely evacuated and the incisions are closed.
EXPLANATORY VIDEO
The PIPAC technique, explained by Dr. Torrent
Dr. Juan José Torrent explains what PIPAC involves and which patients it may help. The video is in Spanish.
PIPAC and HIPEC: how they differ
Both deliver chemotherapy inside the abdomen, but they are used in different situations. HIPEC goes with complete cytoreductive surgery; PIPAC is considered when that surgery is not possible, or not yet possible.
PIPAC
Laparoscopy through small incisions, 45 to 90 minutes. It is repeated several times, every 6-8 weeks, with a 1-2 day hospital stay. It is used to control the disease or to prepare for major surgery.
HIPEC
It is given at the end of major open surgery lasting 6 to 12 hours, usually only once, with a hospital stay of one to two weeks. It has curative intent in selected patients.
Advantages of PIPAC
PIPAC has these advantages over other peritoneal carcinomatosis treatments:
Minimally invasive
Performed laparoscopically through small incisions, allowing rapid patient recovery.
Repeatable
Can be performed multiple times (every 6-8 weeks), allowing sustained treatment of peritoneal disease.
Greater penetration
The aerosol pressure allows chemotherapy to penetrate deeper into tumor tissue than liquid chemotherapy.
Good tolerance
Systemic toxicity is very low, allowing patients to maintain quality of life during treatment.
PIPAC indications
PIPAC is especially indicated in the following situations:
Unresectable carcinomatosis
Patients with extensive peritoneal carcinomatosis who are not candidates for complete cytoreductive surgery with HIPEC.
Neoadjuvant treatment
To reduce tumor burden before definitive cytoreductive surgery, converting inoperable cases to operable ones.
Peritoneal recurrence
In patients with carcinomatosis recurrence after previous treatment with HIPEC or other therapies.
Palliative control
To control malignant ascites and improve quality of life in patients with advanced disease.
It may also be considered in patients who could not tolerate major surgery because of their health or age.
How many sessions are needed
It depends on each case and on how the disease responds. Usually 3 to 6 sessions are planned, one every 6-8 weeks. At each session the surgeon explores the abdomen again and takes biopsies, so the response to treatment can be seen directly.
If the response is good, moving on to cytoreductive surgery with HIPEC may be considered. If the aim is palliative, treatment continues while there is benefit.
Recovery and side effects
The hospital stay is usually 1 to 2 days. Pain is mild to moderate and is controlled with common painkillers, and patients can usually eat the same day or the next. Most patients return to their usual activities within 1 or 2 weeks.
It is usually well tolerated. In the first days there may be mild abdominal pain, nausea, abdominal bloating or tiredness. Serious complications are uncommon.
Our experience in PIPAC
Dr. Juan José Torrent is a PIPAC trainer accredited by the ISSPP (International Society for the Study of Pleura and Peritoneum) and has directed the PIPAC courses in Spain since 2018.
Our team presented its experience with PIPAC in carcinomatosis of gastric and ovarian origin at the international PIPAC congress held in Egypt. At Quenet-Torrent Institute we treat patients with PIPAC following specific protocols, with each case assessed by a multidisciplinary board.
Pathologies treated with PIPAC
The PIPAC procedure is used in the treatment of various pathologies with peritoneal involvement.
Peritoneal carcinomatosis
Treatment of peritoneal tumor spread from various origins.
More information about peritoneal carcinomatosisGynecological tumors
Especially useful in advanced or recurrent ovarian cancer.
More information about gynecological tumorsEsophagogastric tumors
In unresectable gastric carcinomatosis.
More information about esophagogastric tumorsWhere do we perform PIPAC?
We operate in two private hospitals in Spain. The same medical team treats you in Madrid and in Barcelona, with the same surgical and oncological protocols.
Madrid
Memorial Publio Cordón Hospital
Private hospital in Pozuelo de Alarcón with a multidisciplinary team specialised in digestive surgical oncology.
View Memorial Publio Cordón Hospital
Barcelona
Centro Médico Teknon
Private hospital in Barcelona where the team performs high-complexity surgical oncology.
View Centro Médico TeknonFrequently asked questions about PIPAC
What is PIPAC?
It is chemotherapy delivered as a pressurized aerosol inside the abdomen, by laparoscopy. It is used in peritoneal carcinomatosis, especially when the disease is too extensive for complete cytoreduction, and it can be repeated over several sessions.
How long does a person with peritoneal carcinomatosis live?
It depends on the original tumor, on how far the disease has spread and on whether surgery is possible. With systemic treatment alone, published median survival is between 6 and 12 months. When complete cytoreduction with HIPEC is achieved in selected patients, it rises to 40-60 months. PIPAC is considered for patients who are not candidates for that surgery, to control the disease and ascites or to try to make them candidates. Figures by tumor type are in prognosis of peritoneal carcinomatosis.
Is peritoneal carcinomatosis curable?
In some cases, yes. In well-selected patients in whom all visible disease is removed, around 20% can be cured, and results are better in pseudomyxoma peritonei and certain ovarian tumors. When complete surgery is not possible, the aim of PIPAC is usually to control the disease and maintain quality of life.
What is the life expectancy after HIPEC?
It depends on the original tumor and on whether cytoreduction was complete. In the PRODIGE 7 trial, on peritoneal metastases of colorectal origin, median survival exceeded 40 months, and in stage III ovarian cancer the OVHIPEC trial recorded 45.7 months with HIPEC. We explain this in more detail on the HIPEC page.
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What our patients say
L
4 weeks ago
5/5
Wonderful surgical team, among the best out there. Dr. Torrent (expert in peritoneal carcinomatosis) is an exceptional surgeon and an even better person. His coordinator is super kind, fast and efficient. The personal care is excellent and so are the results. This is of vital importance for cancer patients.
K
5 months ago
5/5
In the public healthcare system they gave my father a maximum of one year to live. They only offered him chemo and no hope, said it was impossible, that nothing could be done. He had several tumors inside the peritoneal sac with metastases. A year and a half later he is clean, completely cured. His latest PET scan came back clean. We are very happy. Thanks to Dr. Torrent and his team. THANK YOU.
M
A year ago
5/5
Excellent professionals, especially Dr. Torrent, attentive at all times to the patient (my wife), operated for peritoneal pseudomyxoma. They helped us with all our needs since we came from outside Barcelona. Thank you Elisabeth. We are very grateful to Quenet Torrent Institute, thank you for everything.
P
2 years ago
5/5
I am a 63-year-old patient. They detected adrenal gland cancer and told me there was nothing to be done. I sought a second opinion and they told me about the Quenet Torrent team, specialists in complex operations. Dr. Torrent, from the first moment, told me they could operate. They operated and removed a large tumor mass. I spent a week in the ICU and a month on the ward. Every day he came morning and evening, no matter Saturday or Sunday. Never throw in the towel. I am happy to have found these professionals who gave me my life back. Thank you.
I
3 years ago
5/5
Many thanks for your attention. Dr. Torrent always attentive, involved and decisive. The reception staff very pleasant and always offering the best option. 100% RECOMMENDED. THANK YOU.
M
5 years ago
5/5
Dr. Torrent helped me make the best decision at a difficult moment. I think he is a great professional and a person capable of accompanying you and putting himself in another's shoes. Thank you for everything.
F
6 years ago
5/5
I have peritoneal carcinomatosis. When I sent my diagnosis to every center, practically all of them agreed on palliative chemo with little survival time, since I had a very aggressive type of cell. Until we reached Dr. Quenet, Dr. Torrent and their team. I can only confirm what their CV announces: they are far ahead of the rest. They saved my life, because during the operation the harmful cells that everyone had diagnosed, and that were the reason nobody would operate on me, were not there. This intervention has become the best investment of my life.
M
6 years ago
5/5
The best decision of my life was finding this excellent team of surgeons who saved my husband's life. At a prestigious international clinic in Madrid he was given up for lost with advanced peritoneal carcinomatosis from appendiceal cancer, and thanks to them, the best professionals in this field, he was operated on very successfully. A perfect recovery with no complications, because they were on top of his progress at all times. They have a great quality: from the start they were very honest and close. I can only be deeply grateful; we went to buy time and thanks to them my husband got his life back.
E
7 years ago
5/5
Dr. Torrent is a brilliant surgeon and a very approachable and warm doctor, whose manner reveals all the qualities that make him a great person and professional: perseverance, innate curiosity and a desire to learn, humility, sincerity and empathy. Going through an operation is undoubtedly an intense experience, physically and emotionally, in which anxieties arise and you feel very vulnerable. All of that is normal, and as his former patient I can say that his care and professionalism throughout the process were absolutely exceptional. I felt very supported by him, with the confidence of knowing I was in the best hands. I will always be grateful to him. Moltes gràcies Dr. Torrent!
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Dr. Juan José Torrent presents PIPAC: a medical technique for fighting cancer effectively and in a minimally invasive way
Dr. Juan José Torrent, founder of Quénet Torrent Institute and oncological surgeon, explains in the video what the PIPAC technique involves. PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy) is a technique used to treat patients with inoperable peritoneal carcinomatosis. This procedure delivers chemotherapy as an aerosol inside the abdominal cavity to reduce the tumour mass and turn unresectable tumours (those that cannot be removed by surgery) into resectable ones.
PIPAC experts meet in Egypt for an update on this chemotherapy technique
International specialists in PIPAC for peritoneal carcinomatosis meet in Egypt to exchange experience and progress.
Prognosis and life expectancy in peritoneal carcinomatosis: which factors matter
Prognosis in peritoneal carcinomatosis does not depend on a single figure. Tumour type, extent, cytoreductive surgery and the patient's condition determine the course of the disease.
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