HIPEC SURGERY

Hyperthermic intraperitoneal chemotherapy (HIPEC) surgery is a two-step procedure that treats certain cancers
in the abdomen. Cancerous tumors are surgically removed, and then heated chemotherapy drugs are applied
directly inside the abdomen to eliminate the remaining cancerous cells.
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. 
After all visible tumors are removed, cisplatin, a chemotherapy drug, is heated to 103 degrees Fahrenheit (42
degrees Celsius) and pumped through the abdominal cavity. The patient lies on a special cooling blanket to keep
their body temperature at safe levels. Surgeons physically rock the patient back and forth on the operating table
for about 2 hours to ensure that the drug reaches all areas of the abdomen, killing any cancer cells that remain
after surgery and reducing the risk for cancer recurrence.

What is HIPEC surgery?

 HIPEC surgery involves delivering high doses of chemotherapy into the abdomen to treat cancer that
has spread beyond the organ from which it originated. Abdominal cancers that have spread to the lining
of the abdominal cavity (peritoneum) can be difficult to treat through traditional chemotherapy. HIPEC
surgery provides a more effective treatment option.

Mechanism
Infused chemotherapy diffuses from the intraperitoneal fluid into tissue, interstitial space, and plasma,
similar to peritoneal dialysis. The plasma-peritoneum barrier prevents systemic absorption of the
chemotherapy into the bloodstream thereby limiting toxicity and side effects. Certain agents, like cisplatin
or mitomycin C, are heated to 41 °C-43 °C for an enhanced cytotoxic effect.[19]

What types of cancer does HIPEC surgery treat?

HIPEC surgery can treat diseases, fluid build-up and cancers in the abdomen. The most common cancers treated
with HIPEC include:
Adrenal cancer
Appendix cancer
Colon and rectal cancer
Gastric (stomach) cancer
Liver cancer
Mesothelioma
Ovarian cancer
Pancreatic cancer
Peritoneal cancer

How is HIPEC surgery performed?

HIPEC surgery involves two stages:

Cytoreductive Surgery
 Cytoreductive surgery is the first stage of HIPEC surgery. While you are under anesthesia, your surgeon
will make an incision in your abdomen to view all visible cancerous tumors and diseased tissue.
HIPEC Procedure
 The second stage is the HIPEC procedure. After your surgeon removes all visible tumors and diseased
tissue from the abdomen, he or she will insert a catheter containing the chemotherapy drugs, which are
pumped into your abdominal cavity. The catheters are connected to a perfusion machine, which heats
the chemotherapy drugs and flows them through your abdomen for one to two hours. Your surgeon will
drain the remaining chemotherapy from the abdomen and rinse the abdomen with a salt solution before
the incision is closed.
 The amount of time the procedure takes may vary depending on how much cancer has spread throughout
the abdomen. Advanced stage cancer may take longer to treat with surgery.

Candidate for HIPEC surgery?

 This depends on where your cancer originated and the severity of disease or cancer spread. Your doctor
will determine if you are healthy enough to undergo the procedure.

Chemotherapy agents
Various chemotherapies are used and there is no clear consensus on which drugs should be used.
Mitomycin C and oxaliplatin are the most commonly used agent for colorectal cancer, while cisplatin is
used in ovarian cancer.

What are the benefits of HIPEC surgery?

 HIPEC surgery inserts high doses of chemotherapy directly into the abdomen, where traditional methods
of chemotherapy cannot effectively reach.
 This innovative procedure can improve long-term outcomes and provide more treatment options for
patients who have been diagnosed with inoperable or advanced stage cancer.
 HIPEC has several advantages over standard chemotherapy: 
 It is a single treatment done in the operating room, instead of multiple treatments over several weeks
 90% of the drug stays within the abdominal cavity, decreasing toxic effects on the rest of the body
 It allows for a more intense dose of chemotherapy
 Heated chemotherapy is used on both adult and pediatric patients to treat soft tissue sarcomas, appendix
cancer, Wilms' tumor, desmoplastic small round cell tumors (DSRCT) and other cancers in the
abdominal cavity.

Side Effects
Hyperthermic intraperitoneal chemotherapy has some side effects. Patients must be prepared to receive nutrition
through a feeding tube or IV for about two weeks, while the digestive system recovers from the intense dose of
chemotherapy.