What Is Heated Intraperitoneal Chemotherapy (HIPEC)?

Heated intraperitoneal chemotherapy (HIPEC) is a process of delivering warmed chemotherapy drugs throughout the abdominal cavity during peritoneal mesothelioma surgery.

Traditional chemotherapy for mesothelioma must travel through the bloodstream to reach the treatment site. HIPEC surgery directly washes and circulates the drugs through the entire abdominal cavity, helping prevent peritoneal mesothelioma recurrence.

HIPEC for mesothelioma often accompanies debulking or cytoreductive surgery that removes cancerous masses, tumors or lesions. Many peritoneal patients have significantly benefited from an improved prognosis after HIPEC surgery.

How Does HIPEC Work?

During peritoneal mesothelioma surgery, the surgeon removes as much tumor mass as possible from the abdominal cavity. However, surgery alone doesn’t eliminate microscopic cancer cells that are left behind. HIPEC treatment can kill the remaining cancer cells and prevent a recurrence of tumors.

After the debulking or cytoreductive portion of the procedure, the surgeon uses the HIPEC technique to bathe the abdominal cavity in chemotherapy medication. A HIPEC machine warms the chemotherapy between 104 F and 109 F, below the 111.2 F threshold of killing healthy cells, and delivers the medicine through a catheter pump into the body.

After about 90 minutes and an abdominal massage to mix the solution, a second catheter removes the excess fluid. Temperature probes and a computer screen give the doctor accurate information during the procedure. HIPEC surgery averages between eight and 16 hours, depending on the initial surgery time and extent of cancer growth.

How Long Is the Recovery After HIPEC?

Recovery times will vary based on the extent of the patient’s mesothelioma surgery, but most patients spend about 10 days in the hospital after the procedure. Recovery at home can take several months and involves rest and exercise to overcome fatigue and prevent possible complications.

A healthy diet and regular activity can prevent blood clots and improve energy after the HIPEC procedure. Many patients begin to feel normal again after two to three months. Your health care team will provide complete information on medication, side effects and follow-up appointments during recovery.

Benefits of HIPEC

HIPEC surgery pioneer Dr. Paul Sugarbaker developed the procedure in response to the recurrence of peritoneal mesothelioma cancer after surgery. The treatment improves peritoneal mesothelioma survival rates more than any other therapy, with fewer side effects than traditional chemotherapy.

Dr. Paul Sugarbaker’s 2017 study on HIPEC for mesothelioma included a five-year survival rate of 44% for the trial participants. Other studies indicate a 10-year survival rate as high as 45% after HIPEC surgery. The median overall survival was 67 months after HIPEC, compared to the average of 31 months for patients with the disease.

The Sugarbaker Procedure is another name for the HIPEC technique, and it benefits patients in several ways. Patients who undergo the Sugarbaker Procedure tend to have a better mesothelioma prognosis with fewer cancer-related symptoms.

Additionally, doctors can use all standard chemotherapy types, such as cisplatin and doxorubicin, with the Sugarbaker Procedure. With HIPEC, mesothelioma doctors can administer higher drug dosages more safely than traditional chemotherapy. Less common medications, such as carboplatin, irinotecan, gemcitabine and pemetrexed, are also compatible.

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Who Is Eligible for HIPEC Surgery?

As an aggressive multimodal mesothelioma treatment, HIPEC therapy requires the patient to be in relatively good health. Patients must be able to recover safely after the procedure.

To be eligible for HIPEC, peritoneal mesothelioma patients must have:
  • No history of heart, lung or bowel disease, or other severe chronic conditions
  • No history of multiple bowel obstructions
  • A peritoneal cancer index score (PCI) that indicates cancer is surgically removable
  • Biopsy results of epithelial cell type (surgery may be possible with other cell types)

Patients should consult with a specialist at a peritoneal mesothelioma cancer center to determine eligibility and alternative treatment options. Doctors may make exceptions in some cases or not recommend surgery in others.

Side Effects of HIPEC

HIPEC mesothelioma surgery side effects range from mild to severe and include:

  • Bleeding
  • Blood clot
  • Dehiscence (a wound that does not heal)
  • Fistula (a fusion of two structures or tissues)
  • Perforation (a torn hole in tissue)
  • Wound infection
  • Abscess
  • Sepsis
  • Myelosuppression (decreased blood cells)
  • Pneumonia
  • Bowel obstruction
  • Urinary tract infection
  • Decreased appetite
  • Fatigue

Every patient’s risk for potential side effects will vary, and most patients do not experience severe adverse reactions. However, HIPEC surgery complications are possible, including:

  • Gastrointestinal complications in 4.5% to 19% of patients
  • Pulmonary complications in 10% to 16% of patient
  • Bleeding complications in 4% to 39% of patients
  • Renal complications in 2% to 4% of patients

Peritoneal patients should discuss the benefits versus risks of HIPEC surgery with their mesothelioma specialist. Older patients and those with poor overall health or underlying medical conditions may have a higher risk of HIPEC side effects.