Chewing Gum Flavors to Reduce Postoperative Nausea and Vomiting After PIPAC

Postoperative nausea and vomiting (PONV) are common and distressing complications in the early postoperative period and remain a significant concern despite routine prophylactic antiemetic use. This problem is particularly relevant in patients undergoing Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC), a minimally invasive but physiologically demanding oncologic procedure associated with increased postoperative discomfort.

Chewing gum has been proposed as a simple, non-pharmacological intervention that may reduce postoperative nausea by stimulating salivation and activating the cephalic-vagal pathway, thereby modulating gastrointestinal function. Previous studies in various surgical populations suggest that gum chewing may contribute to improved postoperative comfort; however, evidence comparing different natural flavors and their potential sensory or acceptability-related effects remains limited.

This study evaluates the comparative effectiveness of ginger-mint-flavored versus cinnamon-flavored chewing gum as an adjunct to standard postoperative care in reducing PONV following PIPAC. By comparing two natural flavors within a controlled clinical setting, the trial aims to explore whether flavor-specific sensory stimulation influences nausea perception and patient experience in the immediate postoperative period.

The findings of this study are expected to contribute to the development of simple, low-cost, and patient-friendly supportive care strategies aligned with Enhanced Recovery After Surgery (ERAS) principles for high-risk surgical populations.

Inclusion criteria

• Adults aged 18 years or older undergoing Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC).
• Able to communicate, understand study instructions, and provide written informed consent.
• No known allergy or intolerance to ginger, mint, or cinnamon.
• Able and willing to chew gum for 15 minutes.
• Apfel risk score ≥3 for postoperative nausea and vomiting.

Exclusion criteria

• Postoperative complications requiring intensive care or reoperation.
• Need for rescue antiemetic medication within the first 2 postoperative hours.
• History of psychiatric disorder, neurological disease, or cognitive impairment affecting participation.
• Anatomical or functional limitation preventing chewing (e.g., full dentures, jaw restriction, oral surgery).
• Known phenylketonuria or metabolic intolerance to chewing gum ingredients.
• Active chemotherapy, radiotherapy, or immunosuppressive therapy affecting gastrointestinal function.