HIPEC
Hyperthermic Intraperitoneal Chemotherapy (HIPEC), as an emerging adjuvant surgical procedure for abdominal cancers, has brought new hope to patients with abdominal tumors
What is HIPEC?
Hyperthermic intraperitoneal chemotherapy (HIPEC) is a highly concentrated, heated chemotherapy treatment that is delivered directly to the abdomen during surgery. The procedure treats tumors in the abdominal (peritoneal) lining that stem from colon, gastric, ovarian, appendix tumors, mesothelioma and other cancers.
Unlike systemic chemotherapy delivery, HIPEC delivers chemotherapy directly to cancer cells in the abdomen. This allows for higher doses of chemotherapy treatment. Heating the solution may also improve the absorption of chemotherapy drugs and destroy the microscopic cancer cells that are remaining in the abdomen after surgery. The operation is performed under general anesthesia and lasts for about 6-9 hours depending on its complexity.
HIPEC is a novel technique in which those abdominal malignancies are treated which were previously thought to be untreatable and were only offered palliative care. The indication of HIPEC is therefore very specific and it is meant for those cancer cases of abdomen in which the disease has spread only inside the abdomen and not through the blood or lymphatic. In these patients, the cancer is seen in the form of sand like particles over the inner layer of the abdominal cavity called as the peritoneal sheath. Such type of spread is usually seen in the following cancers:
- Primary peritoneal cancer
- Ovarian cancer
- Appendicular cancer
- Pseudomyxoma peritonei
- Colorectal malignancy
- Some Gastric cancers
How Does HIPEC Work?
The role of intraperitoneal chemotherapy is to maximize tumor penetration and optimize cell death while minimizing systemic toxicity. After removing the visible tumor, the surgeon passes 4 catheters through the patient’s abdomen and pumps a large dose of perfusate containing heated chemotherapy drugs to circulate the perfusion to fill the abdominal cavity and maintain it for a period of time to kill the remaining cancer cells after surgery and reduce the risk of cancer recurrence.
HIPEC procedure steps main include:
HIPEC perfusion: HIPEC is started immediately after cytoreductive surgery. Chemotherapy drug and perfusate are mixed as per the BSA and then pushed into the abdomen through HIPEC machine.
Heating: The temperature of the heated chemotherapy solution is kept at about 42 degrees Celsius. It enhances the effectiveness of the chemotherapy solution, increases the penetration of the solution into the tumor tissue, and helps destroy any possible residual cancer cells that are not visible to the naked eye.
Perfusion and exposure: The heated chemotherapy solution is continuously circulated in the abdominal cavity for a certain period of time (maybe 60 or 90 minutes), which can different according to the protocol and the type of cancer being treated, and the details need to be consulted with the attending physician.
Drainage: After HIPEC treatment, the remaining chemotherapy solution in the abdominal cavity is drained out, and the abdomen is rinsed with normal saline before the incision is sutured, and then sutured.
HIPEC is used to treat various types of abdominal cancer and is considered a specialized and aggressive treatment option, usually when the cancer is confined to the peritoneal cavity and has not spread widely to distant organs. Compared with traditional chemotherapy, chemotherapy drugs in HIPEC treatment will not circulate throughout the body, and the side effects are less.
Why HIPEC?
After the removal of all the visible tumor with the help of cytoreductive surgery, microscopic tumor implants persist in the abdominal cavity and they are invisible to the naked eye. If these tumor implants are left untreated, these cells get implanted at the operated site and the surrounding regions and produce a tumor recurrence.
During HIPEC, the abdominal cavity is rinsed with the help of heated chemotherapy, which kills these tumor cells and prevents their reimplantation, thus minimizing the risk of the tumor coming back.
Moreover, giving chemotherapy directly to the peritoneal cavity reduces some of the common side effects of chemotherapy like hair loss, fall in blood count, nausea and vomiting.
A much larger dose of the drug can be given during HIPEC with minimal side-effects as seen with intravenous chemotherapy and the drug has direct access to the tumor nodules. The combination of heat with chemotherapy could be more effective in destroying the microscopic tumor cells. In some cases, the heat overcomes drug resistance and makes the chemotherapy more effective. The maximum benefit is seen in tumor nodules measuring 2 to 3 mm in size or smaller.
Post-Treatment Recovery: Patients are closely monitored to ensure smooth recovery and optimal outcomes. After the surgery, the recovery of most patients are managed in the intensive care unit for 1 to 2 days. The average hospital stay ranges between 7 to 10 days, depending on the age, physical condition and the extent of surgery performed. At the time of discharge, the patient is able to move around and perform day-to-day activities with minimal help.
Benefits of HIPEC
- Localized Treatment: Chemotherapy is delivered directly to the abdomen, sparing the rest of the body from systemic side effects.
- Enhanced Effectiveness: Heat improves chemotherapy absorption and destroys cancer cells more efficiently.
- Reduces Recurrence: Targets and eliminates residual microscopic cancer cells, lowering the risk of recurrence.
- Improves Survival: Offers a promising option for patients with advanced cancers previously deemed untreatable.
- Minimally Toxic: Focused treatment ensures minimal toxicity compared to traditional systemic chemotherapy.
How does HIPEC differ from traditional chemotherapy?
There are few types of cancers that are difficult to treat, particularly the ones located in the abdominal cavity. These cancers do not get killed with intravenous chemotherapy as with intraperitoneal chemotherapy. HIPEC experts say that the heat makes the chemotherapy more powerful in killing these cancer cells. Hence, we are equipped with a state of art of HIPEC machine that delivers temperature at a constant temperature.
- Allows for high doses of chemotherapy
- Enhances and concentrates chemotherapy within the abdomen
- Minimizes the rest of the body’s exposure to the chemotherapy
- Improves overall survival significantly if done after appropriate patient
- Improves chemotherapy absorption and susceptibility of cancer cells
- Reduces some chemotherapy side effects