Abdominal cancers that spread within the peritoneal cavity are among the most difficult to manage in oncology. Conditions like stomach, ovarian, colorectal, and appendiceal cancers frequently metastasise to the abdominal lining, known as peritoneal carcinomatosis. Historically, this stage of cancer was considered untreatable. However, advancements in surgical oncology—particularly a treatment known as HIPEC surgery—are beginning to shift this outlook.
By delivering heated chemotherapy directly into the abdomen after tumor removal, HIPEC offers a more targeted and potentially life-extending approach to complex abdominal cancers.
What Is HIPEC Surgery?
HIPEC surgery, short for Hyperthermic Intraperitoneal Chemotherapy, is a two-step treatment process involving extensive surgical tumor removal followed by the delivery of warm chemotherapy into the abdominal cavity. The procedure begins with cytoreductive surgery, where the surgeon removes all visible tumors from the peritoneal surfaces. Once this is complete, a heated chemotherapeutic solution is circulated through the abdominal cavity for about 60 to 90 minutes using a specialised machine.
This method is effective because the direct contact between the chemotherapy and the abdominal organs allows the drugs to penetrate cancerous tissues more efficiently. In contrast to conventional chemotherapy, which travels through the bloodstream and affects the whole body, HIPEC targets the cancer cells locally, thereby reducing systemic side effects.
Why Heated Chemotherapy?
Heating the chemotherapeutic solution improves its efficacy in multiple ways:
- Enhanced drug penetration: The warmth allows the drugs to infiltrate tumor tissue more deeply.
- Greater cancer cell destruction: Cancer cells are more sensitive to heat, which can weaken their structure and make them more susceptible to chemotherapy.
- Targeted delivery: Because the treatment is confined to the abdomen, it minimises damage to the rest of the body
This approach helps reduce the common side effects associated with systemic chemotherapy, such as fatigue, hair loss, and immune suppression. Patients often tolerate the treatment better and may experience an improved quality of life during recovery.
Who Is a Candidate for HIPEC?
HIPEC is not suitable for every cancer patient. It is primarily recommended for those with cancers confined to the peritoneal cavity or those that have spread within the abdominal lining. Common conditions treated using this method include:
- Ovarian cancer
- Colon and rectal cancer with peritoneal spread
- Stomach (gastric) cancer
- Appendiceal cancer
- Primary peritoneal carcinoma
- Peritoneal mesothelioma
- Pseudomyxoma peritonei
- Malignant ascites
When used in combination with cytoreductive surgery, HIPEC surgery has shown promising results in extending survival and improving outcomes. For instance, studies show that patients with pseudomyxoma peritonei or colorectal cancer with peritoneal spread often have significantly better survival rates when treated with HIPEC compared to conventional methods.
Benefits of HIPEC Over Traditional Chemotherapy
While traditional chemotherapy is delivered through the bloodstream, HIPEC allows a high concentration of drugs to act directly on the affected tissues. This leads to:
- More effective tumor targeting
- Reduced systemic side effects
- Improved local disease control
The Procedure and Recovery
The full HIPEC procedure can take several hours, depending on the complexity of tumor removal. After surgery, the chemotherapy phase involves circulating the heated solution throughout the abdominal cavity, ensuring full contact with internal organs and tissues.
Postoperative recovery includes:
- Close monitoring in a high-dependency unit
- Gradual reintroduction of food and fluids
- Pain management and infection control
- Follow-up imaging and oncological review
Most patients require hospitalisation for about 7–10 days, followed by a longer recovery period at home. Return to daily activities can vary based on overall health and response to treatment.
Risks and Considerations
Like any major surgical procedure, HIPEC surgery carries certain risks and important considerations, including:
- Risk of infection following surgery
- Bleeding or hemorrhage during or after the procedure
- Chemotherapy-related complications, such as inflammation or tissue damage within the abdomen
- Prolonged recovery time, requiring extended hospital stay and follow-up care
- Need for highly experienced surgical and oncology teams to perform the procedure safely and effectively
- Careful patient selection is based on the following:
- Type and stage of cancer
- Extent of peritoneal disease
- Overall physical condition and organ function of the patient
These factors must be thoroughly evaluated before recommending HIPEC as a treatment option.
Expertise and Innovation in Practice
HIPEC surgery is a complex and resource-intensive procedure that requires advanced infrastructure, skilled surgical teams, and multidisciplinary coordination. In recent years, several high-acuity cancer centres across India have integrated HIPEC into their treatment offerings, particularly in major metropolitan cities.
One such institution, Nanavati Max Super Speciality Hospital, has emerged as an early adopter of HIPEC in Western India, offering this advanced treatment as part of its comprehensive cancer care programme.
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A Shift in the Treatment Landscape
HIPEC surgery represents more than just a technical advancement—it marks a philosophical shift in cancer treatment. By focusing on precise, localised therapy with potentially curative intent, HIPEC is offering a new avenue for patients who were previously left with limited options.
While it is not suitable for every case, it opens the door to improved outcomes and renewed hope for patients with advanced abdominal cancers. As research continues and surgical practices evolve, HIPEC is likely to become an increasingly important part of the oncological toolkit.