Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a specialized treatment for cancers that have spread to the lining of the abdominal cavity (peritoneal surface malignancy). The procedure is performed in a single session, combining extensive surgery with a targeted dose of heated chemotherapy. The duration of this complex operation is notably long and highly variable.
Understanding the Two Phase Procedure
HIPEC combines two distinct, sequential components performed under continuous general anesthesia. This two-step process begins with Cytoreductive Surgery (CRS), which is the physical removal of all visible cancerous tissue from the abdominal cavity. The goal of this initial phase is to achieve a maximal reduction of the tumor burden, leaving behind no visible disease.
The CRS phase requires meticulous dissection and removal of tumors from organs like the colon, stomach, or liver capsule. Once the surgeon determines that no further macroscopic disease can be safely removed, the operation transitions into the second phase, the HIPEC procedure, where heated chemotherapy is circulated directly within the abdominal space.
The Typical Timeline Breakdown
The total time a patient spends in the operating room for the combined CRS and HIPEC procedure generally falls within six to twelve hours. This reflects the scale of the operation, which involves major abdominal surgery followed by a complex drug delivery system. For many patients, the procedure lasts between eight and ten hours.
The Cytoreductive Surgery component consumes the majority of this time, often requiring four to eight hours or more, depending on the volume and location of the cancer. This lengthy period is dedicated to tumor removal, resection of affected organs, and reconstruction of the gastrointestinal tract. The HIPEC phase is relatively short and precisely timed, involving the circulation of the heated chemotherapy solution for a fixed duration, typically 60 to 120 minutes.
After the chemotherapy solution is drained and the abdominal cavity is rinsed, the surgical team begins the final steps of closing the extensive incision and waking the patient from anesthesia. This post-perfusion and closure period usually adds another one to two hours to the total operating room time. The overall duration is therefore dominated by the surgical effort required to clear the disease before the heated chemotherapy can be applied.
Variables That Extend Operating Time
The wide range in operating time is primarily driven by the unique characteristics of the patient’s disease burden and the resulting surgical complexity. The most significant factor is the extent of peritoneal carcinomatosis, which is often quantified using a scoring system known as the Peritoneal Carcinomatosis Index (PCI). A higher PCI score indicates a more widespread distribution of tumors across the abdominal lining, necessitating a much longer and more complex CRS phase.
The need for multi-organ resection also prolongs the procedure. If cancer has invaded nearby structures, the surgeon may need to remove portions of the colon, spleen, gallbladder, or stomach to achieve complete tumor clearance. Each additional organ removal and subsequent reconstruction adds considerable time. Unexpected findings, such as dense adhesions or tumors adhering tightly to major blood vessels, introduce technical challenges that mandate a slower surgical approach.
Immediate Post-Operative Patient Journey
Once the combined CRS and HIPEC procedure is complete, patients are almost always transferred directly to the Intensive Care Unit (ICU) for close monitoring. This specialized environment is necessary due to the major fluid shifts and physiological demands placed on the body by the lengthy surgery and heated chemotherapy.
The typical duration of a patient’s stay in the ICU is usually between 24 and 72 hours, where the care team focuses on managing pain, monitoring organ function, and stabilizing blood pressure. After meeting specific recovery milestones, the patient is then transitioned to a standard surgical floor. The remainder of the hospitalization allows the digestive system to recover and for the patient to regain strength and mobility. The total hospital stay following HIPEC surgery commonly ranges from seven to fourteen days before the patient is discharged home.