by Dr. C.H. Weaver M.D. updated 12/2019
Some doctors recommend combining removal of abdominal cancers with cytoreduction surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC). HIPEC combines abdominal surgery to maximally remove cancer with a “washing” of the abdominal cavity with chemotherapy.
HIPEC has mainly been used to treat ovarian, colon and other cancers of the abdominal cavity.
Part One: Cytoreduction Surgery
Prior to receiving HIPEC a surgeon works to surgically remove all visible cancer from within the abdominal cavity. He or she will also remove any organs with metastatic diseases, such as the small intestine, pancreas, or ovaries. The surgeon can also remove or burn small tumors from vital organs (that cannot be removed), such as the liver.
Part Two: HIPEC Procedure
Immediately following the surgery while still under anesthesia the surgeon performs the HIPEC procedure. Essentially, hyperthermic means "hot" -- not scalding, but warmer than your body temperature. Chemotherapy drugs are warmed because it has been shown that you can potentially increase the effectiveness of the drugs by heating them during delivery.
The word intraperitoneal refers to where the chemotherapy drugs are administered. The inside of the abdomen is coated with a protective membrane called the peritoneum, which surrounds the peritoneal space -- the area where all of the abdominal organs (bowels, liver, pancreas) are enclosed. The chemotherapy drugs are pumped into this space and allowed to basically wash and soak it for up to three hours.
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Recovery from Cytoreduction Surgery with HIPEC
HIPEC is complicated and lengthy and can potentially last up to 14 hours. Recovery is monitored closely in the hospital and most individuals spend up to three to five days in the Intensive Care Unit where they are closely monitored until they are stable enough to be transferred to a routine surgical unit in the hospital. Reported hospital stays following this procedure range from one to four weeks.
What are the potential complications of HIPEC?
HIPEC itself has limited complications as the chemotherapy drugs are, for the most part, concentrated in the abdominal cavity. Due to this, there is a potential for gastrointestinal side effects. There is the potential that the drugs will be partially absorbed and circulate throughout the bloodstream and the side effects from this are usually the same as would be experienced if the chemotherapy was administered systemically.
Who is a Candidate for HIPEC?
The HIPEC procedure is used to treat a variety of metastatic cancers including colorectal, gastric, ovarian and appendiceal cancer. It is not currently a first line treatment or a treatment of choice for someone with early stage or non-metastatic cancer. Age, general health, and most importantly, the type and stage of cancer are what helps the doctor determine if this treatment is an appropriate option.
Patients considering HIPEC should make sure their doctor has explained how HIPEC can improve their outcomes compared to treatment with chemotherapy, surgery or the combination.