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  • Writer's pictureDoç.Dr.Mutlu Ünver

Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Treatment and Surgery Procedure - Assoc.Prof.Dr.Mutlu UNVER Izmir, Turkey

Contents

Introduction


Hyperthermic intraperitoneal chemotherapy (HIPEC), i.e. hot chemotherapy treatment, is a treatment method that involves the administration of heated chemotherapy directly into the abdominal cavity after surgery. The most important step here is to perform an effective surgery.


What is Hyperthermic intraperitoneal chemotherapy (HIPEC)
Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Machine

This procedure is generally used in the treatment of advanced abdominal cancers such as colorectal (large intestine and rectum) cancer, ovarian cancer and mesothelioma.


What is Hyperthermic Intraperitoneal Chemotherapy (HIPEC) and how is it performed?


HIPEC is the delivery of high concentrations of chemotherapy directly to cancer cells in the abdominal cavity, while minimising the systemic side effects associated with conventional intravenous chemotherapy. In other words, cancer cells are given a chemotherapy bath.


Indications for HIPEC


Indications for HIPEC include patients with peritoneal metastases from various primary cancers (such as colon, ovarian and appendix tumours) as well as patients with primary peritoneal cancer (cancer of the peritoneum), i.e. mesothelioma.


HIPEC is usually more effective in combination with cytoreductive surgery after removal of visible tumours in the abdominal cavity. Cytoreductive surgery and hot chemotherapy (HIPEC) has been shown to improve survival rates and quality of life in patients with advanced peritoneal cancer.


Alternative Treatments to HIPEC


An alternative to HIPEC is systemic chemotherapy, which involves the conventional administration of chemotherapy drugs through the bloodstream. While systemic chemotherapy can be effective in treating certain types of cancer, it may not be as effective in treating cancers confined to the abdominal cavity. In these cases, HIPEC or another alternative, PIPACTM, may be more appropriate treatment options.


PIPACTM is pressurised intraperitoneal aerosol chemotherapy, which involves delivering chemotherapy as an aerosolised mist into the abdominal cavity. PIPACTM is a minimally invasive procedure that can be repeated many times and is a potentially attractive option for patients who are not candidates for HIPEC or who have recurrent disease. The most important advantage of PIPACTM is that it is reproducible.


Benefits and Risks of HIPEC


While HIPEC is an effective treatment option for patients with cancerous tissues and metastases in many abdominal lining, there are alternative methods that may be considered for some patients.


Benefits of HIPEC:


  • Higher concentrations of chemotherapy are delivered directly to the cancer cells.

  • It has fewer side effects than systemic chemotherapy.

  • May improve survival rates and quality of life.


Risks of HIPEC:


  • Risk of infection

  • Risk of bleeding

  • Adhesion formation in the abdominal cavity

  • Acute renal failure


Side Effects of HIPEC:


The most common side effects of HIPEC are as follows:

  • Infection

  • Haemorrhage

  • Nausea and vomiting

  • Fatigue

  • Abdominal pain

  • Diarrhoea

  • Constipation


Additional Information About HIPEC:


  • The duration of HIPEC treatment is usually 1-2 hours.

  • It is performed under general anaesthesia.

  • Patients usually stay in hospital for 3-5 days after HIPEC.

  • Side effects of HIPEC are usually temporary and disappear after treatment.


Patient Selection For HIPEC:


HIPEC may not be suitable for every patient. The following criteria play a role in determining whether the patient is suitable for HIPEC:


  • Cancer type and stage

  • General health status

  • How much the abdominal cavity can be cleared of tumours

  • Medical history and other health problems of the patient

  • Patient compliance with treatment


Preparation Before HIPEC


Before HIPEC, the patient must undergo the necessary evaluations and certain precautions must be taken in order to receive general anaesthesia. These precautions are as follows:


  • Cleansing the bowel: Before the operation, it is important that the abdominal cavity is clean. Therefore, the patient should clean the intestines before the operation.

  • Stopping blood thinners: Blood thinners can increase the risk of bleeding. Therefore, the patient should stop blood thinners before surgery.

  • Keeping the patient well hydrated: The most common side effect of hot chemotherapy is kidney failure. To reduce this risk, the patient should be well hydrated before and after surgery. This can be achieved by giving the patient an IV drip.


During HIPEC


Performing HIPEC:


  • HIPEC is performed in the operating theatre under sterile conditions.

  • After the operation is completed, the abdominal cavity is washed with a special solution.

  • This solution contains heated chemotherapy drugs and antibiotics.

  • The solution is kept in the abdominal cavity for about 60-90 minutes.

  • During this time, the solution penetrates the tumour cells and tries to destroy them.

  • The solution is then drained from the abdominal cavity.


After HIPEC


Hospitalisation:


  • Patients usually stay in hospital for 3-5 days after HIPEC.

  • During this time, they are monitored for possible complications such as infection and bleeding.

  • Patients are given painkillers and anti-nausea medications.


Follow-up and Recovery:


  • Patients should undergo regular medical check-ups after discharge.

  • The doctor will follow the patient's recovery process and may recommend additional treatments if deemed necessary.

  • The duration of full recovery may vary depending on the general health status of the patient and the type of cancer.


Additional Information After HIPEC:


  • After HIPEC, patients may experience some temporary side effects such as fatigue, loss of appetite and constipation.

  • These side effects usually disappear over time.

  • It is important for patients to drink plenty of fluids and eat a healthy diet.

  • Your doctor may recommend a special exercise programme for you.

  • Do not hesitate to consult your doctor or nurse if you have any questions or concerns.


Conclusion


HIPEC is a valuable treatment option for patients with advanced peritoneal cancer and offers the chance of better outcomes and quality of life. However, it is important for physicians to consider alternative treatment options such as PIPACTM or systemic chemotherapy in some cases.

By carefully assessing the individual needs and circumstances of each patient with a tumour in the peritoneum, physicians at the Oncology Council can determine the most appropriate treatment approach to achieve the best possible outcomes with HIPEC (Hot Chemotherapy) and PIPACTM treatments.



Assoc.Prof.Dr.Mutlu Unver Best HIPEC Surgeon in Izmir, Turkey


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