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Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Surgery

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

Peritoneal metastases are hard to treat. They're often not as treatable with classic chemo given through the veins. One effective option may be hyperthermic intraperitoneal chemotherapy (HIPEC).

Looking for Regional Perfusion Cancer Treatment?

Surgeons see patients for regional perfusion therapy, which delivers chemo directly to a specific region of the body, at the David C. Koch Regional Perfusion Cancer Therapy Center at UPMC Hillman Cancer Center in Shadyside.

To learn more about HIPEC:

What Is Hyperthermic Intraperitoneal Chemotherapy?

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

Peritoneal metastases may also be called:

  • Peritoneal surface malignancies.
  • Peritoneal carcinomatosis.

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

The aim of CRS is to surgically remove all visible cancer nodules. HIPEC treats small cancer nodules or microscopic (invisible) cancer cells that may be left behind after CRS.

Conditions we treat with HIPEC

We treat the following cancers with hyperthermic intraperitoneal chemotherapy:

  • Late-stage and advanced cancers that have spread to the inner abdominal lining called the peritoneal cavity — Hyperthermic intraperitoneal chemo can treat 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 — Sometimes called secondary cancers, metastases 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 abdominal cavity (peritoneum) and often is linked to asbestos exposure.

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Why Would I Need Hyperthermic Intraperitoneal Chemotherapy?

HIPEC can kill small cancer nodules or microscopic (invisible) cancer cells that may be left behind after cytoreductive surgery (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:

  • Hair loss
  • Mouth sores
  • Nausea

HIPEC surgery is a one-time treatment, given immediately after CRS, which saves you the 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 abdominal cavity.

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

Your outcomes depend on your:

  • Cancer stage.
  • Cancer type.
  • Extent of cancer spread before surgery.
  • Overall health.

Key features of hyperthermic intraperitoneal chemo

  • When used in combination with CRS, HIPEC works best for people with cancers that have spread to and are confined to the abdomen's inner lining.
  • Doctors use HIPEC to treat small cancer nodules or microscopic (invisible) cancer cells left behind after CRS.
  • It provides a more potent dose of heated chemotherapy directly to the abdominal cavity 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.

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What Are the Risks and Complications of HIPEC?

CRS-hyperthermic intraperitoneal chemotherapy carries risks similar to other major surgeries, such as:

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

HIPEC also carries a small risk of gastrointestinal complications, like injuries to the intestines during surgery.

These include:

  • Abscess.
  • Fistula.
  • Leak in the abdominal cavity or intestinal lining.
  • Tear.

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What Should I Expect From HIPEC?

A surgeon often combines HIPEC with cytoreductive surgery (CRS).

Before HIPEC

Before your HIPEC treatment, your doctor will perform 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 microscopic (invisible) tumor nodules.

How long does HIPEC surgery take?

Depending on the number of tumors present, the surgery can last a long time. You'll sleep through the treatment under general anesthesia.

During your HIPEC surgery

For the HIPEC 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 in the abdomen between 105 F and 107.6 F (40.6 C and 42 C).

The HIPEC surgeon will rock you back and forth for about two hours to ensure the chemotherapeutic drug washes over all the cancer cells. This process aims to 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.

Recovery after HIPEC surgery

You'll stay in the hospital for about 10 to 14 days. This will allow your body to heal and your bowel function to return.

During your stay, you'll need an IV for fluids and possibly nutrition. Your digestive system needs time to recover, and you'll work with a dietitian to ensure your body gets the nutrients it needs.

Your doctor or care team will provide details for caring for yourself once you can go home.

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

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.

What's the survival rate of stage 4 peritoneal cancer?

Whether a primary cancer of the peritoneal cavity or a metastatic cancer from another site, stage 4 peritoneal cancer is a terminal illness with challenging outcomes.

The survival rate for stage 4 primary peritoneal cancer ranges from 11 to 17 months. The median survival rate for secondary peritoneal cancer, which has spread to the peritoneum from another site, is about six months.

Other factors, such as the location of the primary tumor, also affect prognosis, with the worst survival rates associated with cancers of:

  • Pancreatic origin – 2.9 months.
  • Gastric – 6.5 months.
  • Colorectal origin – 6.9 months.

When ascites (the buildup of fluids in the peritoneal cavity lining) and liver cancer are present, outcomes may be even lower.  

At UPMC Hillman Cancer Center, we're committed to giving you the specialty care you need to boldly face your cancer.

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Why Choose UPMC for HIPEC Surgery?

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