Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a specialized cancer treatment for certain advanced abdominal cancers. It aims to eliminate microscopic cancer cells remaining after surgical removal of visible tumors.
Understanding HIPEC
HIPEC stands for Hyperthermic Intraperitoneal Chemotherapy. This treatment integrates extensive surgery with the direct application of heated chemotherapy drugs inside the abdominal cavity. The process involves removing all visible tumors, followed by immediate chemotherapy application to target remaining cells.
Heating the chemotherapy solution enhances its effectiveness, allowing deeper penetration into tissues and increasing its toxicity to cancer cells. Administering chemotherapy directly into the abdomen, rather than intravenously, minimizes systemic side effects by limiting bloodstream absorption.
The Surgical Procedure
The HIPEC procedure involves two distinct phases performed sequentially during a single operation. The entire process, including both phases, typically lasts between 6 to 12 hours, depending on the cancer’s complexity. Patients receive general anesthesia throughout the procedure.
The initial phase is Cytoreductive Surgery (CRS), an extensive surgery to remove all visible tumors and affected tissues from the abdominal cavity. This may involve removing parts of organs. Once tumors are removed, the second phase, Hyperthermic Intraperitoneal Chemotherapy (HIPEC), begins. A heated chemotherapy solution, typically maintained between 104 to 109 degrees Fahrenheit (40-43 degrees Celsius), is circulated throughout the abdominal cavity. This solution is circulated for a duration, often ranging from 30 to 120 minutes, to ensure direct contact with remaining cancer cells.
Conditions and Candidacy
HIPEC is primarily considered for cancers that have spread to the lining of the abdominal cavity, known as the peritoneum. Common cancers treated with HIPEC include appendiceal cancer, colorectal cancer with peritoneal spread, ovarian cancer, peritoneal mesothelioma, and certain gastric cancers. It may also be used for rare conditions like pseudomyxoma peritonei.
Not all patients with these cancers are suitable candidates for HIPEC due to the aggressive nature of the treatment. Key selection criteria include limited disease spread, specifically no distant metastases outside the peritoneum. Patients must also be in good overall health and able to tolerate a major, lengthy surgery. A multidisciplinary team evaluates each case, considering factors like the extent of peritoneal disease and the cancer’s responsiveness to chemotherapy.
Post-Operative Care and Outlook
Recovery following HIPEC is extensive, often requiring a stay in the intensive care unit (ICU). The typical hospital stay ranges from 7 to 14 days, though it can be longer for some patients. During this period, patients may receive nutrition intravenously or via a feeding tube to allow the digestive system to recover from the intense chemotherapy.
Common post-operative challenges include pain, fatigue, nausea, and potential complications such as infection or issues with bowel function. Physical activity, like short walks, is encouraged early in recovery to prevent complications and aid healing. Full recovery can take several weeks to months. The long-term outlook for selected patients aims to improve survival and quality of life, with ongoing follow-up care to monitor for potential recurrence. HIPEC can extend survival for certain advanced cancers, though individual outcomes vary based on multiple factors.