Summary

Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is an advanced cancer treatment for abdominal cancers. The surgery is a 2-step process: cytoreductive surgery, followed by HIPEC. During cytoreductive surgery, the operable tumours and lesions are removed from the abdomen. This is followed by a thorough abdominal wash with a heated solution of chemotherapy. The heated chemotherapy technique ensures better penetration of the medication into the tissues and is more effective at killing cancer cells. This technique also requires just one session, and reduces recurrence of the tumours. Higher doses of chemotherapy can be administered this way, with fewer side effects. The peritoneum protects the rest of the body from the harmful effects of the chemotherapy medication. HIPEC is often used to treat colon cancer, stomach cancer, and ovarian cancer. After surgery, patients are typically recommended a 2 to 3 week hospital stay for monitoring. During this time, oncologists will be on the lookout for potential complications, and treat them immediately.

Introduction to HIPEC 

Hyperthermic Intraperitoneal Chemotherapy, often shortened to HIPEC, is a cancer treatment. This method of treatment involves filling the abdominal cavity with heated chemotherapy drugs. For this reason, it is also known as “Hot Chemotherapy”. The HIPEC surgery is performed to treat cancerous growths in the abdomen. It is a 2-step procedure. In the first step, the tumours and lesions are removed surgically. In the second step, the open abdominal cavity is filled with a heated solution of chemotherapy drugs. The chemotherapy pumped through the abdomen this way can permeate the tissues better, and kills any remaining cancer cells in this area. This reduces the risk of cancer recurrence. HIPEC surgery is a very advanced procedure that few surgeons are skilled at performing. Your oncologist can advise you about picking the right surgeon.

Which cancers does HIPEC treat?

HIPEC surgery is used to treat different types of cancers that occur in the abdominal region. This includes:

– Appendix cancer

– Colon cancer

– Rectal cancer

– Gastric (stomach) cancer

– Ovarian cancer

– Mesothelioma

– Peritoneal cancer

– Desmoplastic small round cell tumours (These typically occur in adolescents and young adults)

– Malignant ascites

– Other advanced cancers in the abdominal cavity

Am I a good candidate for HIPEC? 

HIPEC is usually suggested to patients who have advanced abdominal cancers. However, it is not suitable for everyone. Your oncologist is ultimately the best judge of whether HIPEC is right for you. Here are some general guidelines that could help determine if HIPEC is the right option for you :

Medical fitness – The HIPEC procedure can take upto 10 hours in total and the patient’s body needs to be fit enough to withstand this stress. Age, general health condition and fitness will be important factors in determining this.

Operable tumours – HIPEC is usually only recommended in cases where the tumour is operable. This means that the tumour is located in a region which is accessible enough for surgery. The tumour needs to be completely removed in order for the HIPEC to be most effective.

Stage of Cancer – If the cancer has spread to the lymph nodes or blood stream, HIPEC is no longer effective.

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Also Read: When do swollen lymph nodes mean cancer?

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How does HIPEC work? 

The aim of HIPEC surgery is to completely rid the abdomen of cancer cells. Removing tumours and lesions doesn’t guarantee this. The abdominal cavity is lined with a membrane called peritoneum. This sac contains all the abdominal organs. It protects them from infection and impact. When chemotherapy is administered in the conventional way, through the blood vessels, it cannot penetrate the peritoneum. Hence, for abdominal cancers, we need to take a different approach. That’s where HIPEC comes in.

During HIPEC surgery, heated chemotherapy drugs are pumped directly into the abdominal cavity. This is done in a way which allows the medication to penetrate all the crevices of the abdomen and destroy any cancer cells which may be present. The peritoneum, in this case, actually protects the tissues outside the peritoneum from being affected by the chemotherapy. It stops the medication from entering your blood vessels and producing unwanted side-effects in other parts of the body.

During the surgery, the visible cancerous tumours and lesions in the abdomen are first removed surgically. This is called cytoreductive surgery, and constitutes the first stage of HIPEC surgery. In the second stage, the heated solution of chemotherapy medication is pumped into the peritoneum. This is the actual HIPEC procedure. The heated solution is more effective at killing cancer cells, compared to chemotherapy at room temperature. This also allows the oncologists to pump almost 20 times as much chemotherapy solution into the body, with comparatively fewer side effects. The patient is enveloped in cooling blankets to keep their body temperature stable. The catheters pumping the chemotherapy through the patients abdomen are connected to a perfusion machine, which keeps the solution hot and circulates it continuously. The solution is circulated through the patient’s abdomen for 1 to 2 hours. The surgeon may also gently rock the patient or move them side to side, to ensure the chemotherapy washes the abdominal cavity completely.

Once this process is completed, the chemotherapy is pumped out of the body fully, and the abdominal cavity is rinsed out with saline solution. Then the incision is closed, after which the patient will be moved to the Intensive Care Unit for monitoring during their recovery.

What are the benefits of HIPEC? 

The HIPEC procedure allows chemotherapy drugs to target cancer cells in the abdomen, where they cannot reach otherwise. This innovative technique improves the long-term outcomes for cancer patients, resulting in lower chances of recurrence or spreading of the cancer. Patients benefit from HIPEC surgery in the following ways:

Fewer side effects – HIPEC is preferable to traditional chemotherapy because it is a highly targeted approach. The chemotherapy solution is contained within the peritoneum and doesn’t enter the bloodstream, causing it to wreak havoc throughout the whole body. It only affects tissues inside the peritoneum. A very small percentage of the chemotherapy administered is able to penetrate the peritoneum and go outside the abdominal cavity. Your body can safely absorb and get rid of this tiny amount.

Deeper Penetration of Chemotherapy – HIPEC allows the medication to penetrate deeper into the tissues of the abdomen, because it is heated. Moreover, chemotherapy administered systemically, i.e. through the blood vessels, cannot reach the organs and tissues in the abdominal cavity.

Larger doses of Chemotherapy – HIPEC ensures that the chemotherapy medication is administered directly to the affected parts of the body, without leaking out and affecting other parts. This allows the oncologists to administer larger doses of chemotherapy, which are much more effective at completely eliminating all the cancer cells.

Single Session – HIPEC is a good option for cancer treatment because only one session is required to completely eliminate the cancer cells. This is unlike systemic administration, which requires multiple sessions over several weeks. The sessions are often unpleasant for the patient, so it is desirable to finish treatment in one shot.

Risks of HIPEC 

HIPEC can be a life-saving procedure for many patients. However, as with any medical procedure, it comes with certain risks and potential complications:

– Pain
– Nausea and Vomiting
– Diarrhea
– Constipation
– Temporary loss of bowel function
– Bloating
– Weight loss
– Fatigue
– Depression
– Intestinal leaks
– Pancreatic inflammation
– Kidney failure

HIPEC Recovery 

After HIPEC, patients are typically advised to stay at the hospital for 7 to 10 days so the doctors can supervise their recovery. The digestive system and other abdominal organs need this time to recover and return to normalcy. In some cases, patients require a feeding tube to get adequate nutrition while the body recovers. It is normal for patients to extend their hospital stay for even 2 to 3 weeks after HIPEC treatment. During this time, their fluid, electrolyte and insulin levels will be monitored. The doctors will also monitor the patient for all possible side effects and complications, and provide adequate treatment. This could include pain killers, IV fluids and antibiotics.

Looking for exceptional healthcare with personalized treatment plans? Kauvery Hospital, with state-of-the-art branches in Chennai, Hosur, Salem, Tirunelveli, and Trichy, offers a comprehensive range of services, including advanced HIPEC procedures for abdominal cancers. Get expert medical advice and superior patient care at Kauvery Hospital today.

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