Pressurized intraperitoneal aerosol chemotheprapy after misdiagnosed gastric cancer: Case report and review of the literature

World J Gastroenterol. 2018 May 21;24(19):2130-2136. doi: 10.3748/wjg.v24.i19.2130.


We report the first application of pressurized intraperitoneal aerosol chemotherapy (PIPAC) as a rescue therapy before palliative D2 gastrectomy combined with liver metastasectomy performed in a 49-year-old woman with peritoneal carcinomatosis who was primarily diagnosed with and underwent surgery for a Krukenberg tumor. The PIPAC procedure was performed with the use of cisplatin at 7.5 mg/m2 and doxorubicin at 1.5 mg/m2 for 30 min at 37 °C. Eight weeks after the PIPAC procedure, the patient underwent open classic D2 gastrectomy with the creation of a Roux-en-Y anastomosis (RNY) combined with liver metastasectomy. The patient underwent the classic protocol for chemotherapy combined with Xeloda. The patient felt better and returned to her daily activities. Multicenter data should be gathered to confirm the usefulness of PIPAC as a rescue or neoadjuvant supportive therapy in a very select group of patients who have been recently qualified to undergo classic chemotherapy or standard oncologic surgical procedures.

Keywords: Gastric cancer; Krukenberg tumor; Neoadjuvant therapy; Peritoneal carcinomatosis; Pressurized intraperitoneal aerosol chemotherapy.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aerosols
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage*
  • Cisplatin / administration & dosage
  • Diagnostic Errors
  • Doxorubicin / administration & dosage
  • Female
  • Gastrectomy / methods
  • Hepatectomy / methods
  • Humans
  • Injections, Intraperitoneal / instrumentation
  • Injections, Intraperitoneal / methods
  • Krukenberg Tumor / diagnosis*
  • Krukenberg Tumor / surgery
  • Liver Neoplasms / diagnostic imaging
  • Liver Neoplasms / secondary
  • Liver Neoplasms / therapy*
  • Metastasectomy / methods
  • Middle Aged
  • Nebulizers and Vaporizers
  • Neoadjuvant Therapy / methods*
  • Palliative Care / methods
  • Peritoneal Neoplasms / diagnosis
  • Peritoneal Neoplasms / diagnostic imaging
  • Peritoneal Neoplasms / pathology
  • Peritoneal Neoplasms / therapy*


  • Aerosols
  • Doxorubicin
  • Cisplatin