Peritoneal oncology · London
PIPAC (pressurised intraperitoneal aerosol chemotherapy) - private in London.
A laparoscopic day-case delivery of aerosolised chemotherapy for peritoneal metastases from gastric, ovarian and colorectal cancers - done by a named peritoneal malignancy surgeon, in a unit that runs a full CRS with HIPEC programme in the same building.
Why patients choose us
- 01
Named PIPAC surgeon in a peritoneal malignancy unit
Not a general laparoscopic list. A named surgical oncologist trained in PIPAC delivery, in a unit that runs a peritoneal malignancy programme.
- 02
The right procedure for the disease
PIPAC is not the answer for every peritoneal metastasis. If cytoreductive surgery with HIPEC is the better call, we say so before you commit.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
What PIPAC is
Aerosolised chemotherapy, laparoscopically delivered.
Not open surgery. Not intravenous chemotherapy. A precise, repeatable delivery of drug in aerosol form, directly into the peritoneal cavity.
A short laparoscopy of 45 to 60 minutes
One 12 mm port for the nebuliser and one 5 mm port for the camera. A closed CO2 pneumoperitoneum is established at 12 mmHg, and then chemotherapy is aerosolised into it.
Regimen chosen by primary tumour
Cisplatin plus doxorubicin for ovarian and gastric carcinomatosis. Oxaliplatin for colorectal and appendiceal disease. Dosing follows the ISSPP consensus protocols.
Pressure enhances tissue penetration
The 12 mmHg pneumoperitoneum drives the aerosolised droplets into the peritoneal surface at a depth of up to 500 microns, giving 100 to 1000 times higher local concentration than intravenous dosing.
Indicative pricing
What a private PIPAC cycle costs in London.
Indicative ranges across our partner units. Send the imaging and histology and we quote firm figures across two or three options.
In short
A single PIPAC cycle all-inclusive: £8,500 to £14,000, a typical 3 to 4 cycle course: £28,000 to £50,000.
| Procedure | Indicative range | Typical duration | Interval or turnaround |
|---|---|---|---|
| Second-opinion review of imaging and histology | £450–£850 | 45 min | 48 hours |
| Diagnostic staging laparoscopy with PCI scoring | £4,500–£7,500 | 45–60 min | Same visit |
| PIPAC single cycle (ovarian, cisplatin + doxorubicin) | £8,500–£12,500 | 45–60 min | Same visit |
| PIPAC single cycle (gastric, cisplatin + doxorubicin) | £9,500–£13,500 | 45–60 min | Same visit |
| PIPAC single cycle (colorectal, oxaliplatin) | £9,500–£14,000 | 45–60 min | Same visit |
| Typical 3 to 4 cycle course, all-inclusive | £28,000–£50,000 | 4–6 months | 6–8 wk intervals |
Prices vary by unit, by which surgeon does the case, by drug regimen and by whether staging biopsies are billed separately. We come back with a firm quote within one working day.
Where PIPAC is delivered
A short list of UK peritoneal malignancy units.
PIPAC is only offered safely in units that also run a full cytoreductive surgery with HIPEC programme. That backup matters if the MDT decision changes at any cycle.
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Basingstoke Peritoneal Malignancy Institute Private Care
The UK national referral centre for peritoneal malignancy, with the highest PIPAC and CRS with HIPEC volume in the country.
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The Christie Private Care, Manchester
A specialist oncology hospital with a dedicated peritoneal surface malignancy team and full medical oncology backup.
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HCA London Bridge Hospital
A central London private hospital with a peritoneal malignancy service and access to the wider HCA medical oncology network.
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Royal Marsden Private Care
The Royal Marsden Private Care service across Chelsea and Sutton, with peritoneal malignancy surgery integrated with medical oncology.
The journey
From referral to response, what happens, in order.
One team from first message to the third-cycle response verdict, alongside your medical oncologist.
Phase 1 · Before your first cycle
Concierge, off-stage for you
Phase 2 · On the day
A day or one night at the unit
Phase 3 · After
Repeat cycles
- 01
Before
You send us the imaging and histology
A short, confidential form. Recent CT or MRI, PET if done, primary tumour histology, prior surgery notes, and current systemic therapy.
- 02
Before
We come back with a recommendation
Within one working day: whether PIPAC fits, or whether cytoreductive surgery with HIPEC, systemic-only therapy or a clinical trial is the better call.
- 03
Before
We arrange the first cycle
Usually within two to three weeks. Anticoagulants are reviewed. Fasting from midnight. A pre-operative anaesthetic assessment is arranged.
- 04
On the day
Arrival at the unit
Arrival, consent, and a chat with the surgeon and anaesthetist. General anaesthesia, one 12 mm port, one 5 mm port.
- 05
On the day
The PIPAC itself
45 to 60 minutes. A 12 mmHg CO2 pneumoperitoneum, staging biopsies with a Peritoneal Cancer Index score, aerosolised chemotherapy for 30 minutes, evacuation.
- 06
On the day
Day-case or overnight stay
A short recovery in a single room, written aftercare, and home the same day or the next morning. Most patients are back to normal activity in a week.
- 07
After
Repeat cycles and response assessment
Cycles typically repeat at 6 to 8 week intervals. Re-laparoscopy staging biopsies and the PRGS Peritoneal Regression Grading Score guide whether to continue.
Typical end-to-end: 2–3 weeks to first cycle. Cycles: 6–8 week intervals. Response verdict: at cycles two and three.
Who it is for
Peritoneal metastases not suitable for CRS with HIPEC.
A patient group we see often: high Peritoneal Cancer Index, poor performance status for major surgery, prior extensive surgery, or as a bridge to convert into a CRS candidate.
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Recurrent ovarian cancer with peritoneal disease
Platinum-resistant or platinum-sensitive relapse with peritoneal spread not amenable to further debulking surgery.
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Gastric cancer with peritoneal metastases
Positive peritoneal cytology or macroscopic carcinomatosis on staging laparoscopy, alongside systemic chemotherapy.
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Colorectal carcinomatosis, high PCI
Peritoneal Cancer Index above the threshold for cytoreductive surgery, or disease that has recurred after prior CRS with HIPEC.
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Appendiceal or pseudomyxoma disease
Selected mucinous appendiceal neoplasms and recurrent pseudomyxoma peritonei when further open cytoreduction is not appropriate.
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Peritoneal mesothelioma
Diffuse malignant peritoneal mesothelioma as palliative disease control when CRS with HIPEC is not a candidate option.
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Bridge to cytoreductive surgery
PIPAC used to downstage bulky peritoneal disease, with the intention of converting a patient to a future CRS with HIPEC candidate.
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Symptomatic malignant ascites
Recurrent tense ascites causing pain, breathlessness or repeated paracentesis, with PIPAC used for symptom control.
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When PIPAC is not right for you
Bowel obstruction, extensive extra-peritoneal disease, poor performance status (ECOG 3 to 4) or dense adhesions preventing safe port placement.
Regimens and variants
PIPAC is a protocol family, chosen by primary tumour.
What each regimen involves and how it fits with your systemic chemotherapy. Repeatability at 6 to 8 week intervals is the point of the technique.
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PIPAC with cisplatin plus doxorubicin
The standard regimen for ovarian and gastric carcinomatosis. Cisplatin 10.5 mg/m2 and doxorubicin 2.1 mg/m2 aerosolised at 12 mmHg for 30 minutes.
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PIPAC with oxaliplatin
The standard regimen for colorectal and appendiceal carcinomatosis. Oxaliplatin 92 mg/m2 aerosolised in dextrose over 30 minutes at 12 mmHg.
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Electrostatic PIPAC (ePIPAC)
An electrostatic field is applied during aerosolisation to improve tissue penetration and distribution across the peritoneal surface, still in the trial setting.
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Staging laparoscopy with PCI
Standalone diagnostic laparoscopy with Peritoneal Cancer Index scoring and biopsies, before any decision between PIPAC, cytoreductive surgery with HIPEC or systemic-only care.
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PIPAC as a bridge to CRS with HIPEC
Two to three cycles of PIPAC used to downstage carcinomatosis, followed by re-assessment for open cytoreductive surgery with heated intraperitoneal chemotherapy.
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Concurrent systemic chemotherapy
PIPAC is usually delivered alongside standard systemic chemotherapy, with a two-week window either side of each cycle for cytopenia and wound healing.
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Palliative PIPAC for ascites control
For patients with symptomatic malignant ascites, PIPAC can reduce fluid production and interval between paracentesis, even without radiological response.
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Second-opinion review
A specialist review of your imaging, histology and prior operative notes. Sometimes the answer is systemic therapy or a clinical trial, not PIPAC.
Compared to
PIPAC vs HIPEC vs systemic chemotherapy.
Complementary, not competing. Each has a clear role, and the MDT decision turns on your Peritoneal Cancer Index, performance status and prior treatment.
PIPAC
Day-case, repeatable, palliative-intent
A short laparoscopy, one 12 mm and one 5 mm port, day-case or one-night stay. Repeatable every 6 to 8 weeks. Used when CRS with HIPEC is not the right call, or as a bridge to it.
CRS with HIPEC
Major surgery, single-shot, curative-intent
Open cytoreductive surgery of 6 to 12 hours plus heated intraperitoneal chemotherapy. A 10 to 14 day inpatient stay, ITU overnight. Reserved for selected patients where all macroscopic disease can be removed.
Systemic chemotherapy
Backbone, treats extra-peritoneal disease
Intravenous chemotherapy remains the backbone for any patient with peritoneal metastases. PIPAC gives 100 to 1000 times higher local peritoneal concentration, but systemic therapy is still needed for extra-peritoneal disease.
Outcomes, honestly
What the evidence says PIPAC delivers.
A realistic read of the outcomes literature. PIPAC is not a cure and the trial evidence is still maturing, but the results in select patients are meaningful.
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Histological response in 50 to 70%
At three cycles, histological response by PRGS is reported in 50 to 70% of gastric and colorectal peritoneal disease patients who complete the course.
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Symptomatic ascites control
A meaningful reduction in malignant ascites volume and paracentesis frequency is reported in a majority of patients treated for ascites-dominant disease.
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Modest overall survival extension
In selected patients, PIPAC alongside systemic therapy is associated with a 6 to 12 month median overall survival extension over best supportive care. Trial data is still maturing.
Safety and recovery
What to expect afterwards - honestly.
PIPAC is markedly less morbid than open CRS with HIPEC. The things worth planning are your general anaesthetic, the 24 to 72 hour pain window, and the two-week gap on either side of systemic chemotherapy.
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General anaesthesia, day-case or one night
Full general anaesthesia is required. Most patients go home the same day; some stay one night for pain control and observation.
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Post-operative abdominal pain
Mild to moderate abdominal or shoulder-tip pain for 24 to 72 hours is common, from the CO2 pneumoperitoneum and the intraperitoneal chemotherapy.
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Nausea and transient bowel slowdown
Nausea in the first 24 hours, and a slow return of bowel function over 2 to 4 days. Managed with anti-emetics and early mobilisation.
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Bone-marrow suppression is uncommon
Systemic absorption of aerosolised chemotherapy is far lower than intravenous dosing, so cytopenia is unusual but bloods are checked at 7 to 10 days.
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Port-site pain and small hernia risk
One 12 mm and one 5 mm laparoscopic port. Persistent port-site pain in a minority, and a small port-site hernia risk over multiple cycles.
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Adhesions from prior surgery
Dense adhesions from previous major surgery can prevent safe port placement or aerosol distribution. Open conversion is uncommon but possible.
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Response assessment by re-laparoscopy
The most reliable way to assess PIPAC response is a repeat staging laparoscopy with biopsies at cycles two and three, scored with the PRGS.
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Continue systemic therapy in between
PIPAC does not replace intravenous chemotherapy. Your medical oncology team continues systemic treatment between cycles, with a two-week window either side.
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Red flags after discharge
Severe abdominal pain, high fever, persistent vomiting, port-site redness or discharge, or breathlessness. Call the unit or attend A&E the same day.
Reading your operative note
Your PIPAC report in four parts. Read the last one first.
Whichever regimen was used, the operative note the surgeon sends you keeps to the same shape.
A quiet reminder
Peritoneal oncology language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the report before your medical oncology review, just ask.
- 01 Header
PCI score and Peritoneal Regression Grading Score
The Peritoneal Cancer Index across the 13 abdomino-pelvic regions, and the PRGS score from each biopsy site graded 1 to 4.
- 02 Technique
Chemotherapy regimen and delivery parameters
Which drug and dose were used, pneumoperitoneum pressure and temperature, aerosol delivery time, and any electrostatic field application.
- 03 Findings
Ascites volume, biopsy sites and complications
Volume of ascites drained, distribution of macroscopic disease, biopsy sites, and any intra-operative complication or need for open conversion.
- 04 Impression
Response, next cycle and systemic plan
Read this first: the response verdict, the recommended next cycle date, and the recommendation on continuing or changing systemic chemotherapy.
Recognised by major UK insurers
Cover for PIPAC varies by insurer - it is still considered emerging in the UK and often reviewed case-by-case. We confirm cover before booking.
Frequently asked
Everything we get asked about PIPAC.
Quick answers on curative intent, cycle numbers, insurance, MDT and response assessment.
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Is PIPAC a curative treatment?
PIPAC is not curative on its own. It is used as palliative disease control for peritoneal metastases, or as a bridge to downstage disease before cytoreductive surgery with HIPEC. Realistic goals are symptomatic improvement in ascites, histological regression on repeat biopsy, and a modest extension of overall survival compared with best supportive care in selected patients.
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How many PIPAC cycles will I need?
A typical course is three to four cycles at six to eight week intervals, alongside standard systemic chemotherapy. Response is reassessed at cycles two and three with re-laparoscopy biopsies scored with the PRGS Peritoneal Regression Grading Score, and treatment is continued only if there is stable disease or regression.
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Will my insurance cover PIPAC?
PIPAC is still considered an emerging treatment by most UK private insurers. Some insurers cover it under a case-by-case medical review, particularly for recurrent ovarian and gastric carcinomatosis. We check cover before booking and quote self-pay figures so you know both options up front.
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Is it done as an outpatient?
PIPAC is a laparoscopic day-case or 23-hour stay procedure under general anaesthesia. The procedure itself takes 45 to 60 minutes. Most patients are home the same day; some stay one night for pain control. You should plan two weeks away from strenuous activity between cycles.
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Does PIPAC go through an MDT?
Yes. Every PIPAC candidate is discussed at a peritoneal malignancy MDT that includes surgical oncology, medical oncology, radiology and specialist pathology, and where relevant gynae-oncology or upper GI teams. The MDT decides between PIPAC, CRS with HIPEC, systemic-only therapy, or a clinical trial.
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How is response assessed?
Response is assessed by three combined measures: the Peritoneal Regression Grading Score on re-laparoscopy biopsies, changes in Peritoneal Cancer Index at repeat staging, and clinical measures including ascites control, tumour markers and cross-sectional imaging. Imaging alone is unreliable for peritoneal disease.
Related treatments
Looking for something else?
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HIPEC
Heated intraperitoneal chemotherapy with cytoreductive surgery.
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Immunotherapy infusion clinic
Checkpoint inhibitor and cellular therapy infusions.
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Oligometastasis SBRT
Stereotactic body radiotherapy for limited metastases.
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Antibody-drug conjugate infusion
Targeted ADC infusion service for solid tumours.
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Colorectal cancer
Full guide to private colorectal cancer care.
Learn more
Speak to a peritoneal malignancy team
Send us the imaging and the histology. We come back within a working day.
A named consultant, a firm quote across two or three units, and an honest read on whether PIPAC, CRS with HIPEC or a different route is the right call for your disease.