STOMACH CANCER WITH PERITONEAL INVOLVEMENT: NMRRC EMPLOYS RARE PIPAC TECHNOLOGY

A patient from Saransk came to the doctors already with a diagnosis that rarely leaves room for maneuver: stage IV stomach cancer with peritoneal involvement. A large tumor, ascites, and tumor cells that have spread throughout the abdominal cavity. In such a situation, treatment requires not just one solution, but a complex, staged strategy.

Even with competent therapy, such cases are traditionally among the most challenging, as they involve not only the primary tumor but also systemic disease progression.

The patient underwent a full course of medical treatment—eight cycles of chemotherapy—after which he was referred to the National Medical Research Radiological Center of the Ministry of Health of the Russian Federation to assess further treatment options, including the use of PIPAC technology.

By this time, the situation had changed: metastatic peritoneal lesions, previously confirmed, were no longer visually detectable. However, free fluid persisted, indicating a risk of residual tumor cells and ongoing disease progression.

“Even if peritoneal lesions disappear under chemotherapy, this does not mean the disease is fully controlled. Cells may persist, and in such cases, we consider PIPAC as a method of localized impact on the abdominal cavity,” explains Senior Researcher of the Thoracoabdominal Oncological Surgery Department at the P. Hertsen MORI, PhD Nuriddin Abdulhakimov.

During the procedure, specialists performed an abdominal cavity revision, removed ascitic fluid, conducted a biopsy, and carried out the first session of intraperitoneal aerosolized chemotherapy.

The PIPAC method fundamentally differs from standard chemotherapy: the drug is introduced into the abdominal cavity as an aerosol under pressure. This allows the substance to penetrate peritoneal tissue structures and target microscopic tumor foci that cannot be visualized or surgically removed.

After this stage, the absence of tumor cells in the abdominal cavity was confirmed, paving the way for the next key treatment phase.

The patient underwent major surgery—a gastrectomy with formation of a new digestive reservoir from the small intestine. Given the initially high risk of recurrence, treatment was supplemented with a repeat PIPAC session during the surgical intervention.

Thus, the treatment strategy encompassed multiple levels of impact: systemic therapy, localized peritoneal treatment, and radical surgery.

Today, the patient is in the recovery phase. Already in the early postoperative period, he is actively engaged in a rehabilitation program—an essential part of treatment for such extensive interventions and changes in digestive anatomy. The man is now at home, continuing his recovery surrounded by loved ones.