Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) is a novel intraperitoneal drug delivery technique distributing drugs into the abdomen as a pressurized aerosol. Pharmacological advantages are a better homogeneity of drug distribution, a deeper penetration and a higher drug concentration in the target tissue than intraperitoneal chemotherapy with liquids. PIPAC is a generic technique allowing aerosolization of a large range of therapeutic substances. Current indication is palliative therapy of advanced peritoneal metastasis in various gastrointestinal and gynecological tumors. PIPAC has been shown to be feasible in around 90% of pretreated patients, is safe, has no significant organ toxicity and is well tolerated. PIPAC does not deteriorate quality of life. Encouraging efficacy data from four Phase 1-2 clinical studies call for prospective randomized trials. PIPAC is a therapeutic alternative in patients with peritoneal metastasis with who already failed multiple treatment regimens. PIPAC might not be limited to that group of patients in the future. PIPAC might have significant advantages over existing chemotherapy techniques, which are not very effective for treating peritoneal metastasis and are associated a high risk of adverse events.