Hipec Surgery for Ovarian Cancers: Expert Gynaec Oncosurgeon Answers Burning Questions

Did you know that about 60% of ovarian cancers in India are diagnosed when they are in stages 3 or 4?

A few years ago, for ovarian cancer cases in these stages, the prognosis was not as good as it was for early-stage ovarian cancers. The treatments would also severely affect the patient’s quality of life. Nevertheless, things have changed for the better. Today, we have new-age treatment approaches, with which oncologists can treat advanced-stage ovarian cancers effectively and achieve positive clinical outcomes. Today, we see patients getting diagnosed with advanced ovarian cancers, undergoing necessary treatment, and going on to live for 7–10 years, and sometimes more. One such treatment approach in recent times is HIPEC surgery.

Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is an innovative treatment option for ovarian cancer, wherein the surgeon removes visible tumours from the abdomen and then washes the abdominal cavity with heated chemotherapy drugs.

Dr. Kalpana Kothari, a renowned gynaec oncosurgeon and robotic surgery specialist from HCG Cancer Centre, Ahmedabad, answers some of the important questions about HIPEC surgery for ovarian cancers.

Question: What is the primary goal of HIPEC surgery for ovarian cancer?

Dr. Kalpana: The primary goal of HIPEC surgery for ovarian cancer is to remove any visible tumours from the abdominal cavity and kill any remaining cancer cells that may be left in the abdominal cavity after surgery. By delivering heated chemotherapy drugs directly to the abdominal cavity, we can more effectively destroy the cancer cells present there while reducing damage to other healthy tissues in the body.

Question: What to Expect During HIPEC Surgery?

Dr. Kalpana: Before the procedure, an anaesthetic will be administered. The surgery begins with the surgeon making a large incision in the abdomen to gain access to the ovaries and other organs. The surgeon removes all visible tumours from the abdominal cavity, including the ovaries, fallopian tubes, and uterus, if necessary. Once the tumours are removed, the surgeon washes the abdominal cavity with heated chemotherapy drugs at a temperature of about 42–43° Celsius. These drugs circulate throughout the abdominal cavity for a specific amount of time, which is about 60–90 minutes, killing all the residual cancer cells. After this, the surgeon drains the abdominal cavity and closes the incision.

Question: Can all ovarian cancer patients undergo HIPEC surgery?

Dr. Kalpana: Not all patients with ovarian cancer can undergo HIPEC surgery. The procedure is largely recommended for patients with advanced-stage ovarian cancer and those who don’t respond to traditional chemotherapy or radiation therapy. Also, patients with certain health conditions, such as heart or lung disease, cannot undergo this treatment.

Question: How is HIPEC surgery different from traditional chemotherapy?

Dr. Kalpana: Traditional chemotherapy is a systemic therapy, i.e., during this procedure, the drugs are delivered throughout the body. HIPEC surgery, on the other hand, is a localised therapy that targets the specific area where the cancer cells are most likely to be present. This way, we can target the cancer cells precisely and minimise the exposure of the powerful cancer drugs to the rest of the body. This is important in reducing the risk of side effects, like hair loss, changes in the skin and nails, nausea and vomiting, GI disturbances, etc.

Question: What should ovarian cancer patients know about recovery after HIPEC surgery?

Dr. Kalpana: Those patients who undergo HIPEC surgery typically need a longer hospital stay and relatively longer periods of recovery than those who undergo traditional chemotherapy. After the surgery, the patients may experience discomfort and are also susceptible to various treatment-related complications.

Follow-up care is an important part of the recovery process after HIPEC surgery. Patients should meet their treating doctor and regular undergo the recommended tests to ensure that the disease is in remission. Along with keeping up with their doctor consultations, the patients must also adopt a healthier lifestyle that comprises a balanced diet and regular exercises.

Question: Are there any risks associated with HIPEC surgery?

Dr. Kalpana: Just like any other surgical procedure, HIPEC surgery is also associated with certain complications, namely bleeding, damage to nearby tissue in the abdominal cavity, and infection. In most cases, the benefits of this procedure outweigh the risks. However, the surgeon will be explaining the potential risks and complications to the patients and their caretakers before the procedure, allowing them to make an informed health decision.

Question: What are the treatment facilities available for advanced ovarian cancer patients in HCG Ahmedabad?

Dr. Kalpana: At HCG Cancer Centre, Ahmedabad, we have full-fledged treatment departments for all major cancers, including ovarian cancer. We use multidisciplinary and personalised approaches for the management of ovarian cancers. We have specialists from multiple disciplines going through the patients reports and recommending what is best for the patient. When it comes to the HIPEC surgery facility, we have the Performer HT—hyperthermia system from the Rand Institute. This system is designed to deliver chemotherapy drugs to the abdominal cavity with precise, controlled heating and pressure. This helps maximise the effectiveness of the chemotherapy drugs used.

Conclusion

HIPEC surgery is one of the pillar treatments for patients with advanced-stage ovarian cancers. Although not all patients with ovarian cancer are candidates for HIPEC surgery, it can be an effective treatment option for certain cases of advanced-stage ovarian cancer. Newer treatment approaches, like HIPEC, and advanced technologies available in recent times have significantly transformed the cancer care space, where many patients are now coming to believe that it is possible to treat even stage-4 cancer.