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HIPEC (Hyperthermic Intraperitoneal Chemotherapy)

Medically Reviewed by Laura J. Martin, MD on June 13, 2020

What Is HIPEC?

HIPEC stands for hyperthermic intraperitoneal chemotherapy. It’s a cancer treatment that pumps warm chemotherapy drugs into your abdomen. You get one very large dose of chemotherapy, but it's not as toxic. That’s because the drugs aren’t injected into your bloodstream, so they don’t move around your body as much as chemotherapy given through an IV.

The chemotherapy drugs are heated to about 106-109 degrees F. Cancer cells can't handle heat as well as healthy cells. The heat also helps the drugs enter your cells more easily and work better.

HIPEC is major surgery, and you'll spend time recovering in the hospital.

What Cancers Does HIPEC treat?

HIPEC is used for hard-to-treat abdominal cancers, such as appendix and colorectal cancer, as well as peritoneal mesothelioma (a cancer of the lining of the abdomen, often caused by breathing in asbestos). It has also shown promise against ovarian and gastric cancer.

What Happens When You Get HIPEC

You'll be in the operating room for 8-10 hours or more. You'll get general anesthesia, so you won’t be “awake” for it.

First, the surgeon will cut away any visible tumors. This step is called cytoreductive surgery, or CRS. Then, to target any remaining cancer, your abdomen will be filled with heated liquid that has chemotherapy drugs in it.

Your doctor will decide on the exact combination of drugs and length of time they're left in your body based on your unique needs. In most cases, HIPEC lasts between 30-120 minutes. The health care team will rock you back and forth to make sure the drugs get into every nook and cranny. To keep your body's core temperature down during this time, they'll put you on a special cooling blanket.
When enough time has passed, the drugs will be drained from your abdomen, your surgical cut will get stitched up, and you'll move to intensive care to recover.

HIPEC Risks

The most common complications are intestinal leaks, kidney failure, inflammation of the pancreas, sepsis, and a drop in bone marrow and blood cells. Typical side effects like nausea, vomiting, pain, and weight loss usually ease up within 3 months but can last up to a year. Fatigue, sleep problems, bloating, diarrhea or constipation, and depression are also common. One study found that as many as 50% of people dealt with depression within the first year after HIPEC, but that could have happened for reasons apart from HIPEC.

Recovery After HIPEC

After surgery, you'll spend about 2 days in intensive care. Doctors and other health care professionals will check you for fluid loss and will test your electrolytes and blood glucose levels.

You'll get insulin if your blood sugar level gets too high because this can slow down wound healing, make infection more likely, and cause other problems. You'll most likely get antibiotics to help ward off infection. And you'll be given pain meds while the surgical wound heals, probably in the form of an epidural.

As for eating, you might start off with IV nutrition, but the goal will be for you to eat solid foods as soon as possible. Doing so will help get your bowel function back to normal faster.

Once you move out of intensive care, you'll stay at the hospital to continue healing for another 6-20 days, on average, while you recover.

How Effective Is HIPEC?

The research on this is mixed.

Some findings suggest that HIPEC can help people with mesothelioma live about 2-6 years longer. And a study published in The New England Journal of Medicine found that HIPEC improved the life expectancy of women with ovarian cancer by nearly a year.

One study showed HIPEC doubled survival in certain people with colon cancer. But several other studies have found that HIPEC isn’t an effective treatment for colorectal cancer. The National Comprehensive Cancer Network (NCCN) recommends considering HIPEC as treatment in certain patients with colon cancer at centers that are experienced with this treatment.

Your doctor can help you weigh the risks and benefits of all your treatment options, including HIPEC.

WebMD Medical Reference

Sources

SOURCES:

Journal of Gastrointestinal Oncology: "Palliative cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion: current clinical practice or misnomer?" “Chemotherapy for intraperitoneal use: a review of hyperthermic intraperitoneal chemotherapy and early post-operative intraperitoneal chemotherapy.”

American Cancer Society: "Chemotherapy Side Effects."

Indian Journal of Surgical Oncology: "Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Methodology, Drugs and Bidirectional Chemotherapy," "Intensive Care Management of Patient After Cytoreductive Surgery and HIPEC - A Concise Review."

Annals of Translational Medicine: "Malignant peritoneal mesothelioma: a review."

Journal of Clinical & Diagnostic Research: "Preliminary Experience and Morbidity Analysis of Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC) from a Tertiary Cancer Center in India."

World Journal of Surgical Oncology: "Post-operative critical care management of patients undergoing cytoreductive surgery and heated intraperitoneal chemotherapy (HIPEC)."

Journal of Oncology: "Intensive Care Unit Admission After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Is It Necessary?"

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