Hot Chemotherapy or HIPEC Procedure

Hot chemotherapy is an emerging procedure for people with recurrent or metastatic colorectal cancer. Officially, this procedure is called cytoreduction surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). It combines abdominal surgery and peritoneal chemotherapy to attack your cancer in multiple ways at once.

Who is a Candidate for HIPEC?

The HIPEC procedure is used to treat a variety of metastatic cancers including colorectal, gastric, ovarian, mesothelioma, and appendiceal. It is not a front line treatment or a treatment of choice for someone newly diagnosed with non-metastatic colon cancer. If you are considering HIPEC, your age, general health, and most importantly, the stage and grade of your cancer are what helps your doctor determine if this treatment option is right for you. 

Cytoreduction Surgery

Prior to receiving HIPEC, your surgeon will surgically remove all visible tumors within your abdominal cavity. He or she will also remove any organs with metastatic diseases, such as the small intestine, pancreas, or ovaries. The surgeon can also remove or burn small tumors from vital organs (that cannot be removed), such as your liver, at this time. Even if you have already had a bowel resection or debulking procedure for colon cancer in the past, you will need CRS to ensure maximum benefits from the HIPEC.

HIPEC Procedure

Immediately following the surgery while you are still asleep under anesthesia your surgeon performs the HIPEC procedure. Essentially, hyperthermic means "hot" — not scalding, but warmer than your body temperature. The chemotherapy drugs are warmed because it has been shown that you can potentially increase the efficacy of the drugs by heating them during delivery.

The word intraperitoneal refers to where chemotherapy drugs are administered. The inside of your abdomen is coated with a protective membrane called the peritoneum, which surrounds the peritoneal space — the area where all of your abdominal organs (bowels, liver, pancreas) are enclosed. The chemotherapy drugs are pumped into this space and allowed to basically wash and soak it for up to three hours. One common chemotherapy drug used for HIPEC is cisplatin, which is sometimes given with mitomycin C. Mitomycin C is not a chemotherapy drug, but it is used to help slow the growth of certain cancers, such as colorectal cancer.

Recovery From Cytoreduction Surgery With HIPEC

This is a complicated and lengthy operation, which could potentially last up to 14 hours. Your recovery will need to be monitored closely in the hospital. Immediately following the surgery you will most likely spend up to five days in the Intensive Care Unit. Here you will receive close monitoring of your progress until you are stable enough to be transferred to a routine surgical unit in the hospital. Reported hospital stays following this procedure range from a week to a little over a month.

Potential Complications of HIPEC

As with any other major surgery, it's wise to consider the potential risks prior to consenting to the surgery. Any major complications typically arrive from the surgery itself, which can be a serious operation. You may also have complications from multiple days of the tube or parental feedings, which is required following the surgery while your bowel rests. The cytoreduction surgery carries a risk of bleeding, infection, and a possibility of bowel problems or the potential for pneumonia.

The HIPEC itself has limited complications as the chemotherapy drugs are, for the most part, concentrated in your abdominal cavity. Due to this, there is a potential for gastrointestinal toxicity. There is the potential that the drugs will be partially absorbed and circulate throughout your bloodstream, but the side effects from this are usually the same as chemotherapy side effects including:

• Hair loss
• Decreased energy
• Changes in taste
• Nausea and vomiting
• Diarrhea or constipation

Can This Procedure Cure My Cancer?

CRS and HIPEC are only considered in the advanced stages of cancer and used to prolong the quality and duration of your life, not as a curative treatment. Studies have shown that this procedure can help prolong life, but it is not recommended for everyone. In fact, there is no clear survival benefit demonstrated yet with this procedure.

Many cancer centers use this procedure in ongoing research as it is considered a promising, yet unproven, and very aggressive treatment. Prior to the operation, your doctor will explain the risks versus benefits of this procedure, but ask questions if there is anything that you do not understand. 

Frequently Asked Questions

How safe is the HIPEC procedure compared to other treatments?

One study found HIPEC may have fewer risks. In a study of patients with advanced liver, peritoneal, pancreatic, and esophageal cancers, CRS and HIPEC were found to have the lowest mortality risk in the month after surgery compared to other major oncology surgical procedures. For 30 days after surgery, mortality risk was 50% to 70% less for CRS/HIPEC than right lobe hepatectomy, trisegmental hepatectomy, pancreaticoduodenectomy, and esophagectomy.

How long does it take to recover from the HIPEC procedure?

Recovery times vary from person to person, but you can expect to feel fatigued for about two to three months after the procedure. While it's important to rest after surgery, your doctor will probably suggest you try to remain as active as possible to help reduce the possibility of blood clots and other complications.