11 Mar, 2024
11 Mar, 2024
Hyperthermic intraperitoneal chemotherapy (HIPEC) surgery is a technique for delivering high doses of chemotherapeutic drugs in the peritoneal cavity. It is usually performed in patients with peritoneal metastasis. The surgery comprises cytoreductive surgery and HIPEC procedures. In cytoreductive surgery, the cancerous tissue is removed. During the HIPEC procedure, high-temperature chemotherapeutic drugs are infused into the peritoneal cavity to kill the remaining cancer cells.
HIPEC surgery is effective in managing the cancer of organs that are present in the abdominal cavity. Some of the cancers that usually respond to HIPEC therapy are:
HIPEC surgery is an advanced therapy for managing appendix cancer. HIPEC surgery for appendix cancer prolongs survival and enhances the quality of life. Studies have reported using HIPEC therapy in patients with appendix cancer metastasizing to the liver and peritoneum.
HIPEC surgery is also used for the management of both primary and recurrent adrenocortical carcinoma.
HIPEC surgery effectively improves the prognosis of colorectal cancer peritoneal metastases. Some studies have reported a reduced rate of peritoneal metastasis if there is preemptive administration of HIPEC.
Several studies have reported an increased efficacy of HIPEC cancer treatment for stomach cancer compared to cytoreductive surgery. There were higher 1-year, 3-year, and 5-year survival rates with HIPEC in stomach cancer compared to cytoreductive surgery alone.
HIPEC cancer treatment is used as part of a multimodal approach in the management of peritoneal metastasis of hepatocellular carcinoma. Studies have reported that HIPEC chemotherapy is effective in local disease control and improves survival in patients with liver cancer.
Peritoneal cancers originate from the peritoneal cavity lining (primary malignancy) or spread to the peritoneal cavity from the peritoneal organs (secondary malignancies). HIPEC surgery procedure in peritoneal cancer improves overall survival and quality of life.
In advanced ovarian cancer, HIPEC cancer treatment enhances survival. A study found that adding HIPEC chemotherapy to cytoreductive surgery resulted in overall improved and recurrence-free survival, and HIPEC in ovarian cancer does not result in increased side effects.
The HIPEC surgery procedure is an effective treatment option for patients with pancreatic cancer. Studies have reported that the combination of pancreatic resection and the HIPEC procedure is a safe and feasible option with low hemotoxicity.
The HIPEC surgery procedure is primarily done for the management of peritoneal cancers. However, in advanced stages, the technique is also used as a part of palliative therapy in patients with malignant ascites. Further, HIPEC chemotherapy is used in cancer patients experiencing fluid accumulation in the abdomen.
There are two HIPEC procedure steps. The first step is cytoreductive surgery, and the second step is HIPEC.
Cytoreductive surgery is also known as debulking surgery. The surgeon removes the maximum possible cancerous tissues from the abdominal cavity during this surgery. It is an aggressive surgery and may involve the removal of a part or complete organ of the peritoneal cavity. These surgeries may be performed manually or through robotic technology.
After most of the cancerous tissues are removed by cytoreductive surgery, the next step of the HIPEC surgery is to perform the HIPEC procedure. The HIPEC procedure removes the free tumor cells that are not visible to the naked eye. Two techniques are available to perform the HIPEC procedure. These include the open abdomen technique and the closed abdomen technique. The surgeon inserts the catheter into the peritoneal cavity, through which the chemotherapy drug is delivered. The surgeon connects the catheter to the perfusion machine, which heats the drug and delivers it into the peritoneal cavity within one to two hours. The surgeon will then remove the excess chemotherapy drug from the abdomen by rinsing the peritoneal cavity with a salt solution. After the procedure, the oncosurgeon closes the incision and covers it with the dressing.
Once the HIPEC surgery procedure is done, the patient is transferred to the ICU for recovery and is there for about 2 to 3 days. The patient is constantly monitored to maintain vital parameters and manage fluid loss and electrolyte imbalance. The surgeon prescribes antibiotics to reduce the risk of infection and analgesics to reduce pain and inflammation. In cases where the patient has high blood glucose levels, insulin is administered. Nutrition may be started through the parenteral route or through a feeding tube. Gradually, the patient is shifted to solid food to normalize the functioning of the bowel. The patient remains in the hospital for about 10 to 12 days. Certain measures help improve the HIPEC surgery recovery time. These include:
Advantages of HIPEC surgery include:
HIPEC surgery offers targeted treatment for cancers of the peritoneal cavity. The procedure allows the delivery of a high concentration of chemotherapy drugs locally to destroy cancer cells.
Several studies have concluded that HIPEC surgery in patients with peritoneal cavity cancer enhances overall survival and quality of life.
Several minimally invasive techniques have been developed to perform HIPEC surgery to minimize the risk of tissue loss and reduce the recovery period. Minimally invasive surgeries include laparoscopic and robotic surgeries.
The HIPEC procedure aims to deliver high concentrations of chemotherapeutic drugs directly into the peritoneal cavity. Thus, the drug concentration is low in systemic circulation, resulting in a reduced risk of systemic toxicity.
The survival rate of patients with cancer of the appendix, ovaries, colon, rectum, liver, pancreas, and stomach is significantly increased with HIPEC treatment.
Like other advanced and aggressive surgeries, the HIPEC treatment has certain risks and complications. Some of the risks associated with the HIPEC procedure include the following:
Anastomotic leaks and small bowel perforations are the most clinically significant gastrointestinal complications after HIPEC surgery. The digestive non-anastomotic perforation may occur due to the suction effect, focal heat injury, or postoperative shrinking of metastatic nodules. Other gastrointestinal complications include intraperitoneal abscesses, biliary fistulas, prolonged ileus, chyle leaks, pancreatic fistulas, and gastric stasis.
Hematological complications include bleeding, thrombosis, neutropenia, infection, and sepsis. The factors linked to a higher rate of neutropenia include obesity, anemia, female sex, and a history of toxicity to chemotherapy drugs.
Pulmonary complications may prolong the hospital admission duration. The complications include pneumonia and respiratory failure. Studies have reported pulmonary complications in 10% to 16% of patients undergoing HIPEC procedures.
Other complications with the HIPEC treatment include venous thromboembolism, renal insufficiency, vascular access infections, and urinary tract infections. Pancreatic inflammation and reduced bone marrow cells.
Several factors increase the risk of complications in patients undergoing HIPEC surgery. These factors include extensive surgery, greater loss of blood, and prolonged surgery time. In patients with peritoneal metastasis of colon and stomach origin, a high peritoneal cancer index (PCI) reduces overall survival. Skeletal muscle depletion (sarcopenia) is also linked to higher complications. The HIPEC procedure cost depends on the possible risk of complications, among other factors.
HIPEC cancer treatment has several differences compared to traditional chemotherapy. These include:
Compared to traditional chemotherapy, the HIPE procedure ensures a high chemotherapy dose locally in the peritoneal cavity.
The side effects of HIPEC surgery are relatively fewer than those of traditional therapy because of the low systemic exposure to chemotherapy drugs.
Several studies have reported that the HIPEC procedure significantly enhances survival and quality of life more than traditional chemotherapy in patients with peritoneal metastasis.
When the drug is administered directly into the peritoneal cavity, the absorption of the drug and the destruction of cancer cells are higher than in traditional chemotherapy.
HCG Kolkata Centre is one of the leading centers in India for effectively delivering HIPEC cancer treatment. The center has advanced techniques to perform cytoreductive surgery, including laparoscopic and robotic techniques. HCG Kolkata Centre offers a personalized and multidisciplinary approach to delivering HIPEC surgery. The oncosurgeons are in close coordination with the laparoscopic surgeons, gastroenterologists, gynecologists, and anesthesiologists. Further, the procedure is performed with advanced machines, such as the Performer HT—hyperthermia system, to improve the overall outcomes.
HCG Kolkata Centre has a team of expert HIPEC surgeons with several years of experience performing HIPEC surgery with high success rates. The surgeons are trained at international oncology centers under HIPEC surgeons of international repute.
HIPEC surgery is an advanced procedure that involves cytoreductive surgery and chemotherapy. HIPEC surgery aims to improve the survival of patients suffering from peritoneal carcinomatosis, which is common in gynecological and gastrointestinal tumors. The technique offers several advantages over traditional chemotherapy, such as reduced systemic toxicity, improved survival, and targeted therapy. Like other major surgeries, the complications of HIPEC surgery include gastrointestinal, pulmonary, and hematological complications.
Although HIPEC surgery is effective in the management of cancer, the majority of the patients experience recurrence of the disease. The studies have reported a recurrence rate between 31% and 57% at an isolated intra-abdominal location. More specifically, the recurrence rate of peritoneal carcinomatosis is 41% in the first year, 73% in 3 years, and 76% in 5 years after HIPEC surgery.
HIPEC surgery is an advanced and significantly effective surgery for managing patients with peritoneal cancer. HIPEC surgery has significantly improved the 5-year survival rate from a meager 10% to 50% to 90% in patients with appendix peritoneal metastasis and mesothelioma. Further, the 5-year survival rate has also increased to 40% in patients with colorectal cancer and 90% in patients with appendiceal primary tumors.
HIPEC is an advanced procedure to deliver chemotherapy drugs directly at the location of the tumor. It helps in delivering high concentrations of drugs to the place where they are required. Further, the procedure has considerable advantages over traditional chemotherapy.
The oncologists consider several factors before recommending HIPEC surgery to the patients. Patients undergo comprehensive health examinations to evaluate their overall health status. The patients should be healthy enough to tolerate the surgery and post-surgery recovery. The patients should not have severe heart disease or underlying serious chronic conditions. The cancer should not metastasize outside the peritoneal cavity. Further, the patients should also have a low peritoneal cancer index score. Patients allergic to cytotoxic drugs are also not the appropriate candidates for HIPEC.
Like other aggressive surgeries, HIPEC surgery also carries significant risks. Bleeding and infection are the most common complications. Other serious complications include anastomotic leaks, small bowel perforations, kidney failure, sepsis, and pancreatic inflammation.
The duration of HIPEC surgery depends on various factors, such as the extent of the tumor, the location of the tumor, and the number of organs involved. The average time for HIPEC surgery is about 10 to 14 hours. The patients have to remain admitted to the hospital for about 10 to 12 days after the HIPEC surgery.
