HIPEC
Hyperthermic Intraperitoneal Chemotherapy, a surgical treatment performed along with cytoreductive surgery that involves circulation of a hot chemotherapy solution in the peritoneal cavity.
What is HIPEC?
HIPEC stands for Hyperthermic Intraperitoneal Chemotherapy. It is a surgical procedure that is performed in the operating room after all the tumor has been removed with the help of cytoreductive surgery.
HIPEC is performed only once, unlike the intravenous chemotherapy. The chemotherapy drugs that are used for HIPEC may be the same or different from those used for intravenous therapy. The choice of drug also depends on the site of the primary tumor (the tumor from which the peritoneal cancer has arisen).
The Procedure
HIPEC involves circulation of a hot chemotherapy solution in the abdominal cavity for 60 to 90 minutes. During the procedure the temperature in the abdominal cavity is maintained between 41-43 degrees celsius, which is much higher than the normal body temperature. The abdominal cavity may be kept open or closed during the procedure depending on the preference of the surgeon.
HIPEC treatment in India is performed using machines that comprise a roller pump- to circulate the fluid, and a heater to heat the fluid. The fluid is pumped in using 2 or 3 tubes and pumped out using a similar number of tubes. The surgery is considered complete once the entire amount of fluid is pumped out after an hour and a half.
There are different HIPEC machines with varied costs, which are to be borne by the patient. Though, there is no evidence to support the idea that costlier machines may improve the quality of the treatment. This, because the result of the treatment depends on the maintenance of the abdominal cavity temperature to 41 to 43 degrees, and not by the cost of the equipment.
Why HIPEC?
After the removal of all the visible tumor with the help of cytoreductive surgery, microscopic tumor implants persist in the abdominal cavity and they are invisible to the naked eye. If these tumor implants are left untreated, these cells get implanted at the operated site and the surrounding regions and produce a tumor recurrence.
During HIPEC, the abdominal cavity is rinsed with the help of heated chemotherapy, which kills these tumor cells and prevents their reimplantation, thus minimizing the risk of the tumor coming back.
Moreover, giving chemotherapy directly to the peritoneal cavity reduces some of the common side effects of chemotherapy like hair loss, fall in blood count, nausea and vomiting.
A much larger dose of the drug can be given during HIPEC with minimal side-effects as seen with intravenous chemotherapy and the drug has direct access to the tumor nodules. The combination of heat with chemotherapy could be more effective in destroying the microscopic tumor cells. In some cases, the heat overcomes drug resistance and makes the chemotherapy more effective. The maximum benefit is seen in tumor nodules measuring 2 to 3 mm in size or smaller.
Recovery after HIPEC
After the surgery, the recovery of most patients are managed in the intensive care unit for 1 to 3 days. The average hospital stay ranges between 8 to 15 days, depending on the age, physical condition and the extent of surgery performed. At the time of discharge, the patient is able to move around and perform day-to-day activities with minimal help. Though the patient may not regain full appetite, intravenous supplements are no longer required.
During hospitalisation and after returning home, the patient receives physical revalidation therapy for several weeks, which helps in recovery. The patient has to visit the outpatient clinic regularly for monitoring of the physical, social and psychological recovery. When the patient has recovered sufficiently, both physically and psychologically, further treatment is started, as required.
The most important factor that determines the outcome is the quality of cytoreductive surgery. A HIPEC specialist yields better results than a non-specialist.
