PIPAC for Peritoneal Metastases

Inclusion Criteria:

For Unesectable PM Group:

• Age ≥ 21 years old

• ECOG < 3

• Fit for systemic chemotherapy treatment

• Adequate bone marrow function (haemoglobin ≥ 8.0 mmol/L, neutrophils ≥ 1.5X109/L,platelets ≥ 100X109/L

• Adequate renal function (e-GFR > 30mls/min for patients undergoing PIPAC withoxaliplatin; e-GFR > 60mls/min for patients undergoing PIPAC withDoxorubicine/Cisplatin)

• Adequate liver function (Total bilirubin < 1.5 upper limit of normal; ALT and AST< 3upper limit of normal)

• No contraindications to chemotherapy agents oxaliplatin, doxorubicin/ cisplatin

• No contraindications to general anaesthesia and diagnostic laproscopy procedure

• Normal left ventricular ejection fraction (for patients undergoing PIPAC withdoxorubicin/ cisplatin)

• Histological/ cytological proof of PM from GI, HPB, Gynaecology, Breast, Sarcomaprimaries

• Peritoneal-dominant metastatic disease

For the Extensive PM Group:

All the above mentioned criteria as for the unresectable group, with the addition of the following:

• Not suitable for curative cytoreductive surgery (CRS) & hyperthermic intraperitonealchemotherapy (HIPEC) surgery after diagnostic laproscopy - PCI > 18 in LGI, PCI > 6in UGI ECOG < 3

• In UGI PM patients, progression while on bidirectional chemotherapy

Exclusion Criteria:

• Patient is medically unfit for surgery due to concurrent medical comorbidities,including but not limited to intestinal obstruction, multiple sites of metastases

• Any medical or psychiatric condition(s) which would preclude informed consent

• Patient is pregnant or nursing

• GI PM patients with PCI >6 but are treatment naive (these patients should undergostandard treatment - bidirectional intravenous and intraperitoneal chemotherapy)