HIPEC surgery and Peritoneal Surface Oncology: Boon for advanced, recurrent metastatic stage 4 cancer

Stage 4 cancer does not mean end of world.  The cancer which spread to peritoneum was previously untreatable with dismal result. But things have changed. With advances in medical science and technology, we now have a novel technique, cytoreductive surgery popularly called CRS and HIPEC. With HIPEC surgery, we are now moving towards better cancer control.

What is peritoneum? What is peritoneal surface oncology?

Peritoneum is a flimsy thin layer of tissue which covers the inner lining of the abdomen and Visceral organs. The cancers which affect the peritoneum are called peritoneal cancer, Peritoneal carcinomatoses.

Peritoneal surface oncology is  a highly specialized branch of oncology dealing with Peritoneal cancers. These cancers are rare, lesser known and discussed entity and poorly treated across the globe.

What are the types of peritoneal cancers?

Broadly, there are two types of peritoneal cancers.

1. Primary – cancers which develop from the peritoneum like pseudomyxoma peritonii, peritoneal mesothelioma, primary peritoneal cancers
2. Secondary- cancers which spread to peritoneum like cancers of ovary, colon & rectum, stomach

What is CRS and HIPEC ? HIPEC meaning, full form?

It is a two stage procedure.

a. CRS - cytoreductive surgery. It is a major surgery where all visible disease is removed from the abdomen meticulously. It requires 6 – 8 hours.

b. HIPEC - full form is Hyperthermic intraperitoneal chemotherapy. CRS is followed by HIPEC. HIPEC procedure involves administration of heated chemotherapy directly  into the abdomen at a temperature of 42-43 degree C for 90 minutes using a specialised HIPEC machine with strict temperature control. It acts on the microscopic invisible cancer cells for better disease control.

This is an extensive procedure, CRS and HIPEC surgery requires a dedicated team effort and expertise. A team of surgical Oncology, medical Oncology, radiology, pathology, Anaesthesia, ICU critical care, intervention Radiology and rehabilitation.

What are the indications of HIPEC?

Colon cancer, rectum cancer, cancer of ovary, cancer of appendix, pseudomyxoma peritonii, Primary Peritoneal cancers,  peritoneal mesothelioma, cancer of stomach, Peritoneal sarcomatosis and other rare Peritoneal cancers.

What is the cost of HIPEC?

HIPEC is a major surgical procedure and involves effort, resources and cost however, the cost has been brought down because of high volume centre.

What is the result of HIPEC, success of HIPEC?

Stage IV cancer does not mean end of world. For these patients, HIPEC is the only answer offering the maximum chances of cure; some patients are even long term survivors, cancer winners.

We have now been doing this procedure, CRS and HIPEC surgery for the past 7 years with experience of over 100 cases, and good results both short term and long term.