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Hyperthermia Intraperitoneal Chemotherapy

(HIPEC)

“The last chance at cancer cure”

About HIPEC

Cytoreductive surgery (CRS) and heated or hyperthermic intraperitoneal chemotherapy (HIPEC) is a multimodal treatment plan that has significantly improved survival for peritoneal cancer and mesothelioma patients. This procedure can be performed for cancers of abdomen and chest (thorax). The procedure is called HITOC when it is performed for chest, however, the principle remains the same. This procedure can be performed by laparoscopy in selected patients, reducing the trauma and enhancing the recovery.

Dr. Sandeep Nayak

MBBS, MRCSEd, DNB (Gen Surg),
MNAMS (Gen Surg), DNB (Surgical Oncology),
Fellowship in Laparoscopic and Robotic Onco-Surgery.
Dr Nayak is one of the leading senior Surgical Oncologists (cancer surgeon) of Bangalore. He is one of the pioneers of Laproscopic (laparoscopic) cancer treatment (surgery). He is the Director of Surgical Oncology at Fortis Hospital, Bangalore.

Dr. Bharath .G

MBBS, MS, M.Ch
EDUCATION
MBBS from KIMS, Bangalore
MS from NHLMMC, Ahmedabad
M.Ch Surgical oncology from Tata Memorial hospital,Mumbai

WORK EXPERIENCE
Assistant Professor in RRMCH, Bangalore

Dr. V. Sreekanth Reddy

is a surgical oncologist with interest in minimal access cancer surgeries. He finished his MCh (Surgical Oncology) training from Vydehi medical College and later did fellowship in minimal access and robotic Surgical Oncology. He has special interest in Breast cancers, Minimal access surgical oncology and Cytoreduction and HIPEC procedures. He has won award for best surgical video presentation in National conference and Best Abstract presentation in International conference, Korea.

Traditional chemotherapy has little or no effect on these peritoneal cancers.
The HIPEC procedure is developed to improve the relatively poor results of traditional chemotherapy treatment.
Although many patients respond well to unheated chemotherapy drugs, the effects are often short-lived.
Heating is known to increase the effectiveness of chemotherapy.
As HIPEC is given directly on to the cancer, a high dose of chemotherapy can be given avoiding the dose to rest of the body.
The average survival was around six months before HIPEC became available. At present half of patients who qualify for HIPEC surgery live longer than five years. That is a huge difference in survival.

What is peritoneum?

The peritoneum lines the internal surface of the abdominopelvic wall (parietal peritoneum) and other organs inside the abdomen (visceral peritoneum).

What is Pleura?

The pleura lines the internal surface of the chest wall (parietal pleura) and lung (visceral pleura).
Mesothelioma originates in this layer. Like peritoneum many cancers can spread to this layer from other organs.

The cancers can originate in this layer:

Primary peritoneal cancer
Mesothelioma

Spread to this layer:

Ovary
Colon and rectum
Stomach
Many other

What are the kinds of cancer that can be treated with HIPEC?

The most common tumors treated by HIPEC are:

Colorectal cancers
Appendix tumors such as
Pseudomyxoma peritonei
Low-grade appendiceal mucinous neoplasm

Other cancers treated by HIPEC are:

Mesothelioma
Adrenal cancer
Ovarian cancer
Liver cancer
Pancreatic cancer

Overview of HIPEC Surgery

Although the specific approach to HIPEC surgery can vary depending on the treatment center, the general concept is always the same. The procedure has two phases: Cytoreductive surgery followed by heated chemotherapy.

Phase I: Cytoreductive Surgery

At First, surgeons perform cytoreductive surgery (CRS) to remove as much tumor growth as possible from the abdominal cavity. The attempt is to perform a complete removal. This can be performed by open surgery or laparoscopic surgery. Patients for laparoscopic surgery are carefully selected.

HIPEC without surgery is ineffective as the chemo drugs cannot penetrate deep into cancerous tumors. In some cases, complete removal of the tumors is impossible and patients may need to explore other treatment options.

Phase II: Chemotherapy Bath

After CRS any remaining cancer cells are destroyed with heated chemotherapy immediately after surgery to extend survival and prevent cancer recurrence. The chemotherapy drug is circulated at 42 degree centigrade for best effect.

How the HIPEC machine works?

Surgeons place tubes into the abdominal cavity and connect them to the perfusion system, which heats the chemotherapy solution and pumps it to and from the body.
As the solution flows through the machine, a heating element raises it to between to about 40 to 42C. Cancer cells start to die when heated to around this temparature, while normal cells can survive up to 43.9C.
A doctor massages the abdomen by hand or mixes the liquid regularly to ensure the solution is fully mixed. This step helps the drugs reach remaining cancer cells.
This process continues for about 60 to 90 min.
When this is finished, surgeons drain the medicated solution from the body.
The cavity is rinsed with only a saline solution to clear all the drugs before the catheter is removed and incision is closed.

The entire procedure, including CRS and HIPEC, may take between 6 and 12 hours to complete based on the amount of cancer. The more the cancer has spread within the abdomen, the longer surgery will take.

Recovery

HIPEC is a major procedure and after this surgery, you should expect a recovery time of several months. Your treatment team will go over everything you need to know about the recovery process, including how to care for your incision wounds and encourage healing.

The most difficult aspect of recovery is fatigue. It will likely take two to three months until you begin to feel back to normal again. Until then, it is important to follow the advise on nutrition and stay active.

Hyperthermia Intra-Peritoneal Chemotherapy (HIPEC)