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Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Peritoneal Carcinomatosis

Cytoreductive surgery combined with heated intraperitoneal chemotherapy for selected peritoneal malignancies.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Peritoneal Carcinomatosis?

HIPEC is the perfusion of the abdominal cavity with chemotherapeutic agents heated to 41-43°C immediately after macroscopic complete cytoreduction.

The combination of heat and high local drug concentration enhances cytotoxicity, deepens tumour penetration and minimises systemic toxicity.

CRS-HIPEC is the standard of care for selected patients with appendiceal pseudomyxoma peritonei, peritoneal mesothelioma and certain colorectal and ovarian cancers with limited peritoneal disease.

Symptoms

Indications: pseudomyxoma peritonei (low-grade and high-grade)
Indications: peritoneal mesothelioma (epithelioid type)
Indications: peritoneal metastasis from colorectal cancer with low Peritoneal Cancer Index (PCI <20)
Indications: epithelial ovarian cancer (selected primary or interval cytoreduction)
Indications: gastric cancer with limited peritoneal disease in clinical trials
Outcomes: 5-year survival of 60-80% in pseudomyxoma peritonei after complete cytoreduction
Outcomes: 5-year survival of 30-50% in peritoneal colorectal cancer with low PCI

Risk Factors

Patient selection is critical: ECOG 0-1, no extra-abdominal disease, no malignant biliary or ureteral obstruction
Cytoreductive completeness score (CC-0 or CC-1, residual nodules under 2.5 mm) strongly correlates with outcome
Peritoneal Cancer Index (PCI) calculated intraoperatively predicts feasibility of complete resection
Major morbidity (Clavien-Dindo III-IV) occurs in 25-40% of patients
Mortality 1-5% in high-volume centres, higher in low-volume institutions
Renal toxicity from cisplatin or oxaliplatin (cumulative)
Bone marrow suppression and bowel anastomotic leak after long, complex surgery

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Patients with newly diagnosed peritoneal carcinomatosis should be referred to a specialised peritoneal surface malignancy unit
  • Multidisciplinary review by surgical and medical oncology determines candidacy for CRS-HIPEC
  • Pre-existing comorbidities (severe cardiopulmonary disease, malnutrition, age over 75) need careful evaluation
  • Postoperative fever, abdominal pain, drain leakage or sepsis requires immediate inpatient assessment
  • Long-term follow-up is mandatory: CT every 3-6 months in first 2 years, then annually

Treatment Methods

01
Preoperative: laparoscopic staging, CT/MRI for PCI estimation, nutritional and physiological optimisation
02
Surgery: extensive cytoreductive surgery including peritonectomies, omentectomy, multivisceral resection as needed (typically 6-12 hours)
03
HIPEC delivery: closed or open coliseum technique, perfusion temperature 41-43°C for 30-90 minutes
04
Drug selection: mitomycin C for colorectal and pseudomyxoma, cisplatin for ovarian and gastric, doxorubicin for mesothelioma
05
Intensive care management for 1-3 days, total parenteral nutrition or early enteral feeding
06
Postoperative chemotherapy as per primary disease guideline (continued after recovery)
07
Surveillance with imaging and tumour markers (CEA, CA19-9, CA125 as appropriate)

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.