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Hyperthermic Intraperitoneal Chemoperfusion (HIPEC)

Late-stage or advanced cancers can sometimes spread along the abdomen's inner lining , also called the peritoneal cavity. Doctors refer to this type of cancer spread as:

  • Peritoneal metastases
  • Peritoneal surface malignancies
  • Peritoneal carcinomatosis

Peritoneal metastases can result from a variety of cancers. The most commonly result from cancers of the colon, appendix, ovaries, stomach, and mesothelioma.

Peritoneal metastases are hard to treat. They are often not as treatable by classic chemo given by the veins.

What Is HIPEC?

Hyperthermic intraperitoneal chemoperfusion (HIPEC) is a type of advanced regional perfusion cancer therapy. During HIPEC, doctors deliver very high doses of heated chemo directly into the abdomen to treat peritoneal metastases.

Doctors generally use HIPEC combined with and immediately after a specialized surgical procedure called cytoreductive surgery (CRS).

CRS aims to surgically remove all visible cancer nodules, while HIPEC aims to treat small cancer nodules or invisible (microscopic) cancer cells that may be left behind after CRS.

Key Features of HIPEC

  • When used in combination with CRS, HIPEC works best for people with cancers that spread to and are confined to the abdomen's inner lining.
  • Doctors use HIPEC to treat small cancer nodules or invisible (microscopic) cancer cells left behind after CRS.
  • HIPEC provides a more potent dose of heated chemotherapy directly to the abdomen but with fewer side effects than classic chemo given in the veins.
  • It can effectively treat early-stage cancers with little spread.
  • For more aggressive or advanced cancers, your doctors may use CRS-HIPEC with other therapies, like standard chemo given in the veins.

Contact Us About Regional Perfusion Cancer Treatment

Surgeons see Koch Center patients at UPMC Hillman Cancer Center in Shadyside.

To learn more about regional perfusion therapy, contact the David C. Koch Regional Perfusion Cancer Therapy Center or call UPMC Hillman Cancer Center at 412-692-2852.

HIPEC can kill small cancer nodules or invisible (microscopic) cancer cells that may be left behind after CRS.

At the same time, most chemo stays in the abdomen, which helps avoid common side effects seen with chemotherapy given orally or in the veins, including:

  • Mouth sores
  • Nausea
  • Hair loss

HIPEC is also a one-time treatment, given immediately after CRS, which saves you many trips to an infusion center required for IV chemotherapy.

CRS-HIPEC may improve long-term survival for some people with hard-to-treat cancers confined to the abdomen.

It may reduce the return or spread of cancer in the abdomen. For some conditions, the procedure also works as a palliative measure to provide relief from symptoms.

Your outcomes depend on:

  • Your overall health
  • Cancer type
  • Cancer stage
  • The Extent of spread of cancer before surgery

Your doctor can provide more details about the impact of CRS-HIPEC.

CRS-HIPEC carries risks that are similar to other major surgeries, including:

  • Bleeding.
  • Infection.
  • Blood clots (early activity after surgery can reduce this risk).
  • Poor nutrition or weight loss.

HIPEC also carries a small risk of gastrointestinal complications, such as injuries to the intestines during surgery. These include:

  • Fistula.
  • Abscess.
  • Tear.
  • Leak in the abdomen or intestinal lining.

Talk to your doctor about your risks.

  • Late-stage and advanced cancers that have spread to the inner abdominal lining called the peritoneal cavity. HIPEC can treat a variety of advanced cancers that have spread to the abdomen, including cancers of the colon, stomach, appendix, and ovaries, as well as mesothelioma. It may be an option for people resistant to other treatments.
  • Metastases. Metastases, sometimes called secondary cancers, are cancers that spread from the original tumor to other parts of the body. Some are too advanced to remove with surgery. But, when confined to the abdomen (peritoneal metastases), HIPEC may be an option.
  • Peritoneal mesothelioma. This type of cancer arises from the inner lining of the abdomen (peritoneum) and is often linked to asbestos exposure.

A surgeon often combines HIPEC with CRS.

First, your doctor performs CRS to remove all visible cancer nodules (or as much of the tumor as possible).

HIPEC immediately follows CRS to treat any leftover small or invisible (microscopic) tumor nodules. The surgery itself can last a long time, depending on how many tumors are present.

You will sleep through the treatment under general anesthesia.

For the HIPEC part of the procedure, the surgeon inserts small tubes and temperature probes into the abdomen:

  • One tube delivers the heated chemotherapy solution into your abdomen.
  • The other tube circulates the fluid back to a heating element to maintain a temperature between 105 and 107.6 F (40.6 C to 42 C) in the abdomen.

The surgeon will rock you back and forth for about two hours to ensure the chemotherapeutic drug washes over all the cancer cells. This process aimsto kill any remaining cancer within the abdomen.

At the end of CRS-HIPEC, the surgeon:

  • Turns off the pump and allows your body to return to a normal temperature.
  • Flushes the abdomen with a saline solution to clear out the medicine.
  • Removes the tubes and temperature probes, and sews the incisions.

You can expect to stay in the hospital for approximately 10 to 14 days. This is to allow the body to heal and bowel function to return.

You will need an IV for fluids and possibly nutrition during your recovery. Your digestive system needs time to recover. You'll work with a dietitian to make sure your body gets the nutrients it needs.

Your doctor or care team will provide details for caring for yourself once you're allowed to go home.

You may feel fatigued for a few months after surgery. Stay active during this time but within your doctor's limits, such as slow walks throughout the day.

Your doctor will also design a follow-up care plan for you. You'll need routine scans or blood tests in the coming years to watch for cancer recurrence.

Learn More About HIPEC

UPMC has vast experience performing CRS-HIPEC. Only a few medical centers in the country perform as many of these procedures yearly as UPMC.

To learn more about HIPEC: