PIPAC and HIPEC are treatments for certain abdominal cancers like peritoneal mesothelioma. The main difference between PIPAC and HIPEC is how they administer chemotherapy. PIPAC uses high pressure to push chemo drugs into tumors. HIPEC uses heat to make chemo drugs more effective at killing cancer cells.

What Is PIPAC?

PIPAC stands for pressurized intraperitoneal aerosol chemotherapy. It is a cancer treatment that fills the abdomen with pressurized chemo drugs. It targets cancers that start in or spread to the abdominal lining.

What Is HIPEC?

HIPEC stands for heated intraperitoneal chemotherapy. It is a cancer treatment that washes the abdomen with heated chemo drugs. It targets cancers that start in or spread to the abdominal lining.

PIPAC and HIPEC have similarities and differences that may matter to mesothelioma patients. Similarities include the targeted area of the body and the limited reach of the chemo drugs. PIPAC and HIPEC differ in how they are administered, who qualifies for treatment and what patients can expect from each procedure.

How Do PIPAC and HIPEC Differ From Traditional Systemic Chemotherapy?

Systemic or traditional chemotherapy involves injecting chemo drugs into the bloodstream. The injected drugs can go wherever the bloodstream takes them. PIPAC and HIPEC are types of local chemotherapy. This means PIPAC and HIPEC apply chemo drugs to a specific region of the body. Systemic chemotherapy may cause more side effects than local chemotherapy because of this difference.

PIPAC and HIPEC Are Different Ways of Administering Chemotherapy

PIPAC and HIPEC are forms of local chemotherapy, meaning they do not go through the bloodstream. With these treatments, doctors put chemo drugs only inside the lining of the abdomen (the peritoneum). This allows the drugs to come into direct contact with tumors in this location.

But PIPAC and HIPEC use different approaches to administer chemo drugs:

  • PIPAC administers chemo as a high-pressure aerosol. This approach allows the drug to reach more tumor cells than standard chemotherapy.
  • HIPEC administers chemo as a heated solution that bathes the peritoneum. This approach causes tumors to absorb the drug more readily. The high temperature can also kill cancer cells.

PIPAC and HIPEC Both Treat Peritoneal Cancers

PIPAC and HIPEC are both treatments for cancers within the abdominal lining (peritoneum). This can include cancers that develop in the abdominal lining or those that spread there. Doctors may also recommend PIPAC or HIPEC as a palliative treatment to help control symptoms.

Which Cancers Do PIPAC and HIPEC Treat?

The following cancers may be treated with HIPEC or PIPAC:

  • Appendiceal cancer
  • Colorectal cancer (colon cancer)
  • Gastric cancer
  • Ovarian cancer
  • Peritoneal mesothelioma
  • Pseudomyxoma peritonei*
  • Uterine cancer☨

*Indicates HIPEC treatment only
☨Indicates PIPAC treatment only

Eligibility for PIPAC and HIPEC can depend on many factors, including the type of cancer a patient has. Any patient interested in PIPAC or HIPEC should discuss these treatments with an experienced oncologist. The doctor can explain why an individual may or may not benefit from either therapy.

Eligibility Factors for PIPAC Compared to HIPEC
Patients for whom other treatments did not work may qualify. ✔️ ✔️
Patients must have generally good health to qualify. ✔️ ✔️
Patients who could not tolerate traditional chemo may qualify. ✔️ ✔️
Patients who are ineligible for cytoreductive surgery (CRS) may qualify. ✔️ ✖️
Patients who are ineligible for HIPEC may qualify. ✔️ ✖️
Patients with fluid in the abdomen (peritoneal effusion) may qualify. ✔️ ✔️
Patients with scar tissue from past abdominal surgeries may not qualify. ✔️ ✔️
Patients with tumors or obstructions of the bowel or intestines may not qualify. ✔️ ✔️
Patients with tumors outside of the abdomen or in lymph nodes may not qualify. ✔️ ✔️

PIPAC and HIPEC Procedure and Recovery Comparison

A PIPAC or HIPEC treatment involves at least one small surgical procedure. Both therapies occur in a hospital or surgery center under general anesthesia. The specific steps of the two procedures differ significantly.

The PIPAC Procedure

  • Overview: Doctors use special equipment to inflate the space within the abdominal lining (peritoneum). Pressurized chemotherapy goes into the inflated space and stays for about a half hour.
  • Full Duration: 1 – 1.5 hours
  • Recovery: Patients may spend a few hours or days in the hospital after PIPAC.

The HIPEC Procedure

  • Overview: After surgery, doctors fill the peritoneum with a heated chemo fluid. The chemo circulates for 1.5 hours or longer before a doctor drains it.
  • Full Duration: 6 – 8 hours including surgery
  • Recovery: Patients may spend 7 – 12 days in the hospital after surgery and HIPEC. Post-procedure fatigue can last for 2 – 3 months.

PIPAC and HIPEC Benefits and Risks

Both types of procedures come with potential positives and negatives. Oncologists can explain how the benefits and risks may apply to individual patients.

Comparing the Benefits and Advantages


  • Can extend survival for some patients
  • Can reduce cancer symptoms, including abdominal swelling and pain
  • Generally does not cause significant kidney or liver damage
  • May shrink tumors enough to make some patients eligible for surgery
  • Safe for qualified patients to receive multiple rounds of treatment
  • Treats cancer with a higher concentration of chemo compared to traditional chemo


  • Can extend survival for some patients
  • Can reduce cancer symptoms, including abdominal swelling and pain
  • Causes fewer side effects than traditional chemotherapy
  • May help prevent cancer recurrence
  • Puts chemo drugs in direct contact with tumors on abdominal surfaces, unlike traditional chemotherapy
  • Uses a higher concentration of chemo drugs than traditional chemotherapy can

PIPAC and HIPEC procedures come with several potential risks and side effects. Some occur more rarely than others. In general, both treatments are considered safe for and well-tolerated by qualified patients. Interested individuals should speak with their oncologists to understand how these risks may affect them.

Comparing the Risks and Side Effects


The following side effects may occur during or because of PIPAC:

  • Fever
  • General discomfort
  • Infection
  • Intestinal injury
  • Mild abdominal pain
  • Nausea
  • Skin reaction
  • Spread of cancer to new sites


The following side effects may occur during or because of HIPEC:

  • Abscess
  • Blood clots
  • Digestive issues
  • Fatigue
  • Fistula formation (abnormal connection between two body parts or tissues)
  • Infection
  • Severe bleeding
  • Tissue perforation (a hole)
  • Wounds that will not heal (dehiscence)

Availability of HIPEC and PIPAC in the United States

One key difference between HIPEC and PIPAC is how available they are in this country. Many cancer centers and doctors offer HIPEC in the United States.

PIPAC procedures require more specialized equipment and training for healthcare providers. In September 2023, only one cancer center in the United States openly offered PIPAC treatment: City of Hope. Even that center only offers PIPAC through a clinical trial at this time.

Which Is More Effective: PIPAC or HIPEC?

PIPAC and HIPEC can be helpful, effective procedures that improve quality of life for qualified patients. Only an experienced oncologist can determine which may offer more benefits for a given patient. Mesothelioma patients interested in these procedures should discuss them with a specialist.