AbstractBackground The landscape of pressurized intraperitoneal aerosol chemotherapy (PIPAC) for peritoneal surface malignancies has evolved from a purely palliative option to an intervention increasingly explored in upfront and neoadjuvant settings. Bevacizumab is a key component of modern systemic therapy in this context but is traditionally discontinued 6–8 weeks before surgery because of concerns about wound-healing and other complications, potentially compromising oncologic efficacy. This study aimed to evaluate the safety of uninterrupted bevacizumab-based systemic therapy in patients undergoing PIPAC. Patients and methods We conducted a retrospective analysis of a prospectively maintained database of all patients undergoing PIPAC between January 2023 and May 2025. PIPAC cycles were categorised as those in which patients received uninterrupted perioperative bevacizumab (BEV group) and those without bevacizumab (non-BEV group). Results Overall, 111 patients underwent 202 PIPAC cycles (98 BEV; 104 non-BEV). In the BEV group, the mean interval between preoperative bevacizumab and PIPAC was 19.5 days, and bevacizumab was resumed a mean of 4.4 days post-PIPAC. There was no 30-day mortality. Bevacizumab use was not significantly associated with overall morbidity on univariate analysis (5.1% vs 9.6%; p=0.221). Exploratory multivariate analysis, limited by sparse events, likewise did not show a significant association with morbidity (odds ratio 0.64; 95% CI 0.19–2.1; p=0.46). Conclusion In this retrospective cohort, uninterrupted bevacizumab between PIPAC cycles was not associated with increased morbidity, supporting the feasibility of continuing bevacizumab without routine interruption in carefully selected patients. Larger multicentre prospective studies are needed to confirm these observations and explore causal effects.
Somashekhar et al. (Mon,) studied this question.