Impact of pressurized intraperitoneal aerosol chemotherapy on adhesion formation in the combined treatment of ovarian cancer with peritoneal carcinomatosis

Purpose of the study. To assess the dynamics of the Peritoneal Adhesion Index (PAI) and the number of involved anatomical regions of the abdominal cavity in patients with ovarian cancer and peritoneal carcinomatosis during consecutive sessions of pressurized intraperitoneal aerosol chemotherapy (PIPAC).

Patients and methods. A single-center observational study with intraoperative assessment of adhesive status was performed in 87 patients. PAI and the number of involved abdominal regions were determined during three PIPAC sessions and at delayed diagnostic laparoscopy. Available completed paired observations were used for interval comparisons. The primary endpoint was the change in total PAI; secondary endpoints were changes in the number of involved regions and the overall direction of changes by the time of delayed laparoscopy. The statistical significance of paired changes was assessed using the sign test.

Results. Between the 1st and 2nd PIPAC sessions, a decrease in PAI was recorded in 57 patients (65.5 %), no change in 24 (27.6 %), and an increase in 6 (6.9 %); the mean change was – 2.7 points (p < 0.0001). Between the 2nd and 3rd PIPAC sessions, a decrease in PAI was observed in 35 patients (38.9 %), no change in 53 (58.9 %), and an increase in 2 (2.2 %); the mean change was 0.89 points (p < 0.0001). Between the 3rd PIPAC session and delayed laparoscopy, a decrease in PAI was observed in 14 patients (16.1 %), no change in 70 (80.5 %), and an increase in 3 (3.4 %); the mean change was 0.10 points (p = 0.006). Overall, a decrease in PAI from baseline to delayed laparoscopy was recorded in 56 patients (64.4 %), no change in 22 (25.3 %), and an increase in 9 (10.3 %); the mean cumulative change was 3.7 points (p < 0.0001). A similar pattern was observed for the number of involved regions: an overall decrease was recorded in 54 patients (62.1 %), no change in 24 (27.6 %), and an increase in 9 (10.3 %); the mean cumulative change was 1.32 points (p < 0.0001).

Conclusion. The sequential use of PIPAC was associated with a reduction in the severity and extent of abdominal adhesions, indicating a favorable safety profile of PIPAC and the technical feasibility of repeated laparoscopic procedures.

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