Hyperthermic Intraoperative Peritoneal Chemotherapy (HIPEC)

What is hyperthermic intraperitoneal chemotherapy (HIPEC)?

Hyperthermic intraperitoneal chemotherapy (HIPEC) is a specialized cancer treatment. It is used to treat cancer that has spread inside the abdomen – the area of the body that holds the stomach, liver, intestines, and other important organs. During HIPEC treatment, surgeons first remove visible cancer with cytoreductive surgery. Then warm (heated) chemotherapy drugs are circulated inside the abdomen to kill any remaining cancer cells that cannot be seen.

HIPEC alone is rarely a cure for cancer, but it can help some patients live longer and improve their quality of life.

HIPEC is typically used to treat metastatic cancers (cancers that have spread from their original location to the inside of the abdomen). These include:

• Appendix cancer
• Colorectal cancer
• Ovarian cancer
• Stomach cancer HIPEC can also be used to treat cancers that have started in the abdomen, such as:
• Primary peritoneal cancer
• Peritoneal mesothelioma
• Pseudomyxoma pertonei

What happens during HIPEC treatment?

HIPEC treatment happens in two stages during a single surgery. The first stage is called cytoreductive surgery (CRS), where a surgeon removes all visible cancer and affected tissue from inside the abdomen. During the second stage, a thin tube (called a catheter) is placed into the abdomen and connected to a machine that warms the chemotherapy medicine to around 41°C. The warm medicine is gently pumped into the abdominal area and circulated to ‘wash’ the inside of the belly.

The chemotherapy drugs are then drained from the abdomen, the area is rinsed clean, and the surgeon will close the incisions.

The full procedure, including both the cytoreductive surgery and the HIPEC treatment, can take between 5 to 10 hours, depending on how much cancer is found.

After HIPEC, you may stay in the intensive care unit (ICU) for close monitoring. A ventilator may be used to help with breathing in the early recovery phase. A feeding tube may be needed while you recover. This ensures you receive nutrition as HIPEC can affect the function of your bowel.

During your recovery from HIPEC, you may experience side effects such as a bloated stomach, diarrhea, constipation, nausea, pain, swelling, and fatigue.

Recovery will depend on individual factors but can take up to 12 weeks.

What are the benefits of HIPEC?

HIPEC puts chemotherapy directly into the abdomen, instead of sending it through the whole body using the bloodstream like regular (systemic) chemotherapy. The inside of the abdomen is covered by a thin layer called the peritoneum, which usually blocks chemotherapy from reaching cancer in that area. HIPEC works by going around this layer and attacking cancer cells directly inside the abdomen.

HIPEC heats chemotherapy, making it more potent and powerful at killing cancer cells. It is also applied directly, allowing it to penetrate tumors, killing their cancerous cells.

HIPEC treatment is completed in a single treatment session, whereas systemic chemotherapy involves multiple sessions over time.

HIPEC is only delivered to the abdomen, meaning there are fewer side effects than systemic chemotherapy

What are the risks associated with cytoreductive surgery and HIPEC?

Like all major surgeries, cytoreductive surgery and HIPEC carry some risks, including infection and bleeding. Risk will vary depending on the extent of the cancer and the chemotherapy drugs used. Your doctor will talk to you about these risks and explain everything clearly before your treatment.

Can cancer return after HIPEC surgery?

Cancer may return to the abdomen after HIPEC treatment, or it may develop elsewhere in the body if the cancer has spread. For many people though, HIPEC gives them a longer life with less symptoms.

Treatment outcomes will depend on many factors, which your doctor will discuss with you before treatment.