Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Overview

 A hyperthermic intraperitoneal chemotherapy (HIPEC) is used to treat malignant tumors located in the abdominal (peritoneal) cavity, which includes the area that holds the stomach, intestines, and liver. Throughout this process, healthcare providers use the two-step procedure by removing the malignant tumors and then flood the abdominal cavity with elevated temperature or heated chemotherapy medications.

HIPEC is used by healthcare providers to treat cancer that has metastasized (spread) from another area of the body to the abdomen. HIPEC may prolong the patient’s cancer-related life, but it does not cure the disease.

Malignant tumors and cancerous tissue are surgically removed, and any remaining cancer cells are targeted with heated chemotherapy to eliminate them. Nevertheless, there is a risk of malignancies reappearing within the abdominal cavity following surgery. Similarly, if cancer from another part of the body metastasizes to the abdomen, it can give rise to additional tumors in the same area.

Reasons for undergoing the procedure

When a patient has metastatic cancer that has moved from another area of their body into their abdomen, healthcare providers usually utilize HIPEC. In deciding if HIPEC is the best course of action for the patient, their healthcare provider will take into account:

• The general physical strength.
• In the event that the patient has further medical problems.
• The type of cancer that has spread to the abdomen.
• Any surgical history.

HIPEC is commonly used by healthcare providers to treat metastatic tumors, such as:

• Adrenal cancer.
• Appendix cancer.
• Colorectal cancer.
• Gastric cancer or stomach cancer.
• Liver cancer.
• Mesothelioma.
• Ovarian cancer.
• Pancreatic cancer.
• Peritoneal cancer.
• Pseudomyxoma pertonei.

Risk

Surgical procedures carry inherent risks such as the potential for significant bleeding and infection. The specific malignancy type and the choice of chemotherapeutic drugs administered during and after surgery can influence the risk associated with Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Patients undergoing HIPEC will receive a thorough discussion from their surgeon regarding these risks.

The following list are the side effect of HIPEC, this includes:

• Bloating.
• Constipation or diarrhea.
• Depression.
• Fatigue.
• Nausea and vomiting.
• Loss of bowel function temporarily.
• Pain.
• Weight loss.

Procedure

There are two steps to HIPEC surgery:

• Cytoreductive Surgery: The initial step of HIPEC surgery is called cytoreductive surgery. The surgeon will make an abdominal incision while the patient is unconscious to inspect any obvious malignant tumors and damaged tissue.
• HIPEC procedure: The HIPEC technique is the second step. A catheter holding the chemotherapy medications will be inserted and pushed into the abdominal cavity by the surgeon once all visible tumors and diseased tissue have been removed from the the stomach. The chemotherapy medications are heated and pumped through the abdomen for one to two hours using a perfusion machine that is attached to the catheters. Before closing the incision, the surgeon will remove any remaining chemotherapy from the abdomen and give it a salt solution washing.

During the procedure

One of the two steps of the procedure is called hyperthermic intraperitoneal chemotherapy (HIPEC). The first step is cytoreduction, which is surgery to remove injured abdominal tissue and malignant tumors. Steps in the treatment process include:

• After receiving general anesthesia, the patient won’t experience any discomfort during the course of therapy.
• The abdomen will be cut open by the surgeon, who will then remove any malignant tumors and damaged tissue.
• Their surgeon will make an abdominal incision and place a catheter (or catheters) while they are still under anesthesia.
• The chemotherapy will be heated to around 108 degrees Fahrenheit (41 degrees Celsius) by a machine that is attached to the catheter or catheters.
• The chemotherapy will be pushed into the abdomen through the catheter by a pump.
• The body may be gently shifted from side to side by the surgeon to ensure that the whole abdominal cavity is covered in the heated chemotherapy medicine.
• Depending on the severity of the abdominal cancer, the therapy might take several hours.
• After treating the patient, the surgeon will empty the abdomen and clean it with saline to remove the chemotherapy medicines.
• Any incisions made during the operations will be closed by the surgeon.

The extent to which the cancer has progressed throughout the abdomen will determine how long the surgery takes. Surgery may be required to treat cancer in an advanced stage.

After the procedure

Depending on the type of surgery used to remove the malignant tumor, the circumstances will change. A feeding tube may occasionally be required in order to provide the patient with nourishment while their body heals.

Large dosages of strong chemotherapy are used in HIPEC, which may have an impact on bowel function. Once they receive therapy, most patients remain in the hospital for a few days to two weeks.

Outcome

This innovative technique offers advanced or terminally ill cancer patients expanded treatment options and the potential for improved long-term outcomes.

There are a few benefits that HIPEC has over traditional chemotherapy.

• The patient may experience fewer severe side effects because the body can safely absorb and eliminate the small quantity of chemotherapy that does leak out, and since 90% of the chemotherapy stays in the abdominal cavity.
• In a part of the body that systemic chemotherapy cannot reach or often doesn’t help, the patient will get medications that destroy cancer. The peritoneum is a barrier that systemic chemotherapy cannot get through since it travels throughout the entire body. This is the membrane that encircles the organs that are housed in the abdominal cavity.
• More malignant cells that remain after surgery can be destroyed by giving them higher dosages or more potent chemotherapy.
• Instead of needing several therapy sessions spread out over several weeks, the patient will be able to finish treatment after just one session.

Recovery following treatment can take anywhere from four to twelve weeks, with a few days to two weeks spent in the hospital.

Call the healthcare provider following HIPEC if they encounter:

• Fever
• Nausea and vomiting.
• Severe swelling.
• Drainage at the incision site.
• Pain that worsen overtime.