HIPEC perfusion pumps and PIPAC nebulisers

Hyperthermic intraperitoneal chemotherapy needs a perfusion circuit: a roller pump, a heat exchanger, inflow and outflow cannulas placed in the abdomen and temperature probes, with the chemotherapy (mitomycin, oxaliplatin, cisplatin or doxorubicin) circulated for 30 to 90 minutes at about 41 to 43 degrees after cytoreductive surgery has removed all visible disease. Purpose-built systems replaced adapted cardiac bypass equipment: the Belmont Hyperthermia Pump, ThermaSolutions' ThermoChem HT-2000, RanD's Performer HT and Gamida's SunChip log temperature and flow and are cleared for the procedure in their markets, and the same circuits perform hyperthermic intravesical chemotherapy and isolated limb perfusion. Pressurised intraperitoneal aerosol chemotherapy, introduced in 2011, uses a nebuliser (the CapnoPen from Capnomed, later Reger Medizintechnik) attached to a standard high-pressure injector to spray a low dose of drug into the gas-inflated abdomen during laparoscopy, giving deeper and more even drug distribution at a fraction of the systemic dose; it is repeatable every few weeks for peritoneal metastases from gastric, ovarian, colorectal and pancreatic cancer that cannot be resected.

The devices are the easy part: HIPEC's benefit depends on complete cytoreduction and is proven mainly in pseudomyxoma peritonei and mesothelioma, questioned in colorectal cancer after the PRODIGE 7 trial and supported in ovarian cancer by the OVHIPEC-1 trial; PIPAC has palliative and disease-control data but no randomised survival evidence yet. Both concentrate in a small number of specialist centres.