Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a specialized, two-part treatment for advanced cancers that have spread to the lining of the abdominal cavity, known as the peritoneum. This intensive, combined approach pairs extensive surgery with a targeted chemotherapy wash. The technique is reserved for carefully selected patients whose disease is confined primarily to the abdominal region.
The primary goal is to eliminate all visible cancer and eradicate any remaining microscopic cancer cells. By focusing the treatment directly on the affected area, HIPEC aims to reduce the risk of cancer recurrence and can significantly improve survival rates for certain individuals with peritoneal surface malignancies. This complex undertaking requires a highly skilled surgical oncology team.
The Cytoreductive Surgery Component
The first and most complex phase of the procedure is Cytoreductive Surgery (CRS), sometimes called debulking. This major operation must be performed before the chemotherapy is delivered. The surgeon systematically removes all visible tumor deposits from the abdominal organs and the peritoneal lining, which may require removing organs or parts of organs, such as sections of the colon, spleen, or gallbladder.
The success of the entire HIPEC treatment relies on the completeness of this surgical removal. The goal is to achieve maximal tumor removal, often referred to as an R0 or R1 resection, meaning no visible cancer remains or only microscopic disease is left behind. If the surgeon cannot remove most of the tumor, the patient receives little benefit from the subsequent chemotherapy portion.
After tumor removal, the surgical team prepares the patient for the direct administration of chemotherapy. This involves placing specialized catheters or tubes into the abdominal cavity to allow for the infusion and circulation of the heated solution.
Delivering Hyperthermic Chemotherapy
The second phase, the HIPEC portion, begins immediately after the cytoreductive surgery, with the patient still under general anesthesia. The abdomen is either temporarily closed or held open with a specialized device, creating a closed or semi-closed circuit for drug delivery. A solution containing chemotherapy drugs, such as Mitomycin C or Cisplatin, is then pumped directly into the abdominal cavity through the implanted catheters.
This solution is heated to a temperature range of approximately 41°C to 43°C (106°F to 109°F) by an external heat exchanger. This hyperthermia is a deliberate strategy, as cancer cells are more sensitive to elevated temperatures than healthy cells. The heat also enhances the effectiveness of the chemotherapy drugs, helping them penetrate the tissue and increasing their ability to kill cancer cells.
The heated chemotherapy is circulated throughout the peritoneal cavity for a specific duration, typically ranging from 30 to 120 minutes. This localized delivery method allows for a much higher concentration of medication to reach the cancer site than if given intravenously. Since the chemotherapy is mostly contained within the abdomen, only a small amount is absorbed into the bloodstream, which minimizes systemic side effects common with traditional IV chemotherapy.
Applicable Cancers and Patient Suitability
HIPEC is specifically indicated for certain types of advanced abdominal cancers that have spread to the peritoneum. The most commonly treated malignancies include appendiceal cancer, colorectal cancer that has metastasized to the peritoneal lining, and primary peritoneal cancers like mesothelioma and ovarian cancer. This therapy is most successful when the cancer spread is limited to the abdominal cavity and has not moved to distant organs outside the peritoneum.
Patient suitability is determined by strict selection criteria, as the combined surgery and chemotherapy is demanding on the body. Physicians use tools like the Peritoneal Cancer Index (PCI) to quantify the extent of the disease; a low PCI score, typically under 20, is necessary to proceed. The patient must also be in good overall health, with a favorable performance status and manageable comorbidities, to withstand the lengthy procedure and recovery.
A detailed pre-operative assessment, often including imaging and diagnostic laparoscopy, is performed to ensure the disease is resectable and that no widespread metastasis exists outside the abdomen. The procedure is generally reserved for individuals where the surgeon is confident they can achieve a complete removal of all visible tumors. This strict patient selection process is necessary to maximize the chance of a positive outcome and minimize the high risks associated with the treatment.
Post-Procedure Recovery and Outcomes
Following the extensive surgery and chemotherapy, patients face a demanding recovery period reflecting the intensity of the treatment. The hospital stay is usually prolonged, often lasting one to two weeks, and may include a few days in the intensive care unit for close monitoring. During this initial phase, the medical team closely manages pain and monitors for complications, such as infection, bleeding, and gastrointestinal issues.
A common challenge is the temporary delayed return of normal bowel function, or ileus, due to the manipulation and high-dose chemotherapy within the abdomen. Patients may initially require nutrition through an intravenous line or a feeding tube until their digestive system begins to recover. Recovery at home is a long process, typically taking three to six months before patients feel fully recovered.
For highly selected patients, the outcomes of CRS and HIPEC can be significantly more favorable than traditional treatments alone, offering improved long-term survival for certain peritoneal surface malignancies. For instance, certain appendiceal cancers and peritoneal mesothelioma have demonstrated a meaningful survival benefit with this combined approach. While HIPEC does not guarantee a cure, it offers a pathway to extended progression-free survival and a better quality of life.