Learn all about HIPEC surgery and procedure used to treat cancer. Cytoreductive surgery (CRS) and Hyperthermic intraperitoneal chemotherapy (HIPEC) combined have been recognized as standard of care for treatment of a subset of patients with peritoneal carcinomatosis (PC).
Hyperthermic intraperitoneal chemotherapy (HIPEC) is a cancer treatment that involves filling the abdominal cavity with chemotherapy drugs that have been heated. Also known as “hot chemotherapy,” HIPEC is performed after the surgeon removes tumors or lesions from the abdominal area. Unlike systemic chemotherapy delivery, which circulates throughout the body, HIPEC delivers chemotherapy directly to cancer cells in the abdomen. This allows for higher doses of chemotherapy treatment. Heating the solution may also improve the absorption of chemotherapy drugs by tumors and destroy microscopic cancer cells that remain in the abdomen after surgery.
Aside from the growing number of studies reporting better survival after HIPEC, one of the procedure’s main draws is its less severe side effects. With traditional chemotherapy, drugs enter the bloodstream and travel throughout the entire body. The drugs kill any cells that rapidly multiply a key characteristic of cancer. A major downside of this approach is that it harms healthy cells that also multiply quickly, causing well-known chemotherapy side effects like hair loss and nausea.
HIPEC, on the other hand, is a loco regional therapy a technical way of saying it only treats the area where the cancer formed. Because heated chemotherapy drugs stay within the abdominal cavity, the approach minimizes the rest of the body’s exposure to chemotherapy.
HIPEC is a viable treatment option that has been shown to extend and improve patients’ quality of life. Unlike other cancer treatments that treat the symptoms of abdominal cancers, HIPEC can actually stop the growth of abdominal cancers. HIPEC can provide drastic improvements to life expectancy, with some peritoneal patients surviving years after the procedure. In one study involving more than 100 peritoneal mesothelioma patients, 26 patients survived for more than five years after the procedure. Remarkably, 19 patients were alive seven years later.
Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
Hyperthermic Intraperitoneal chemotherapy (HIPEC) is a highly concentrated, heated chemotherapy treatment that is delivered directly to the abdomen during surgery. Heated or Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is the process of heating chemotherapy drugs and delivering them to the abdomen right after surgery. This treatment option is a highly effective approach for peritoneal mesothelioma. Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a multimodal treatment for peritoneal mesothelioma and other abdominal cancers. The procedure combines surgery and a special approach to chemotherapy. It has significantly improved survival for peritoneal mesothelioma patients, but the role of heated chemotherapy in pleural mesothelioma treatment is less clear.
HIPEC Chemotherapy Treatment for Cancer
Intraperitoneal chemotherapy is a treatment sometimes used for ovarian cancer, which often spreads into the abdominal cavity. This chemotherapy technique delivers chemotherapy drugs directly into the abdominal cavity through a catheter (thin tube). Intraperitoneal chemotherapy directly targets cancer cells in the abdomen, reducing drug exposure to healthy tissues. Intraperitoneal chemotherapy provides a concentrated dose of drugs to the cancer cells in the abdominal cavity. Intraperitoneal chemotherapy may be a treatment option for women with ovarian cancer that has spread inside the abdomen. Another form of this treatment is called Hyperthermic Intraperitoneal chemotherapy (HIPEC), which circulates heated chemotherapy drugs throughout the abdomen during surgery. HIPEC is performed in the operating room during a surgery to debulk a tumor. The chemotherapy in this procedure is first warmed and then infused directly into the intraperitoneal cavity.
HIPEC Surgery Procedure
Hyperthermic Intraperitoneal chemotherapy (HIPEC) involves bathing the abdomen with heated chemotherapy before final closure of the patient. The procedure includes following steps:
- Temperature probes are inserted to monitor temperature
- In-flow and out-flow catheters are placed in abdomen
- Abdomen is sutured closed
- Saline solution is used to rinse the abdomen
- Heated chemotherapy (about 107 degrees) is added to the solution
- Surgeon gently massages abdomen help chemotherapy coverage
- Chemotherapy is drained
- Abdomen is rinsed with saline solution once more
- Patient is reopened, catheters and probes are removed
- Abdomen is finally closed
The goal of this procedure is to kill as many microscopic mesothelioma cells that were not removed by the surgery. There are also reduced side effects compared to regular chemotherapy. The process takes about 60-90 minutes.
HIPEC Side Effects
Hyperthermic Intraperitoneal chemotherapy has some side effects.
- An increased risk of leakage of bowel junctions (anastomoses) due to the heated chemotherapy. In case of increased risk of leakage, the surgeon can judge that it is safer to temporarily create a stoma (the bowel is exteriorized through the abdominal wall).
- Fluid accumulation in the pleural cavity (the space between the lungs and the thoracic cage), especially when tumor was removed from the diaphragm. In case of tumor at the diaphragm, the surgeon will put a tube (thoracic drain) in the thorax as a preventive measure to drain any fluid after the operation for some days.
- Slow emptying of the stomach for about two weeks. Complications of the chemotherapy itself (lowering of white blood cell count, lowering of platelet count) can occur after a HIPEC, depending on the drug and the dose that is used, but are usually rare.