HIPEC

Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is an advanced surgical procedure used in the treatment of select abdominal cancers. This technique combines surgery with heated chemotherapy and is primarily employed to treat cancers that have spread to the lining of the abdomen (peritoneum), such as peritoneal carcinomatosis originating from colorectal cancer, gastric cancer, ovarian cancer, and mesothelioma. HIPEC aims to target and eliminate microscopic cancer cells that remain after the surgical removal of visible tumors, thereby reducing the risk of cancer recurrence and improving survival rates.

Procedure

The HIPEC procedure is performed in two main steps. First, the surgeon conducts cytoreductive surgery (CRS) to remove visible tumors within the abdomen. This is followed by the administration of HIPEC, where a heated chemotherapy solution is circulated throughout the abdominal cavity for a specific period, usually 60 to 120 minutes. The heat enhances the effectiveness of the chemotherapy by improving drug absorption and penetration into the tumor cells, while also directly killing cancer cells that are sensitive to heat.

Indications

HIPEC is indicated for patients with certain types of cancers that have spread to the peritoneal surface, including:

• Colorectal cancer
• Gastric cancer
• Ovarian cancer
• Mesothelioma
• Pseudomyxoma peritonei

Benefits and Risks

The primary benefit of HIPEC is its potential to significantly extend survival in patients with peritoneal carcinomatosis, which is often considered a terminal condition. Additionally, because the chemotherapy is confined to the abdomen, systemic side effects are minimized compared to traditional chemotherapy.

However, HIPEC is a complex and lengthy procedure that carries significant risks, including infection, bleeding, and complications related to the chemotherapy drugs used. The procedure is also associated with a lengthy recovery period.

Selection Criteria

Not all patients with peritoneal carcinomatosis are candidates for HIPEC. Selection criteria include:

• Good overall health and performance status
• Limited spread of cancer within the abdomen
• Absence of significant disease outside the abdomen

Outcomes

Studies have shown that HIPEC, when combined with cytoreductive surgery, can improve survival rates in patients with peritoneal carcinomatosis from colorectal and ovarian cancers, among others. However, outcomes vary depending on factors such as the type and extent of cancer, the completeness of tumor removal, and the patient's overall health.

Conclusion

HIPEC represents a significant advancement in the treatment of peritoneal carcinomatosis, offering hope to patients with this challenging condition. However, due to its complexity and potential risks, it is important that patients are carefully selected and treated at specialized centers with experience in this procedure.