What is HIPEC Surgery?
HIPEC stands for hyperthermic intraperitoneal chemotherapy.
Hyperthermic intraperitoneal chemoperfusion is a new way to give chemotherapy. Hyperthermic means heated. HIPEC puts heated chemo drugs right into the abdomen. For patients needing abdominal cancer treatment in which certain advanced cancer cells that have spread to the lining of the abdomen, HIPEC can be a source for new hope. The goal of HIPEC is to prevent these cells from growing into new tumors and causing cancer to return.
In HIPEC, surgeons first remove any tumors they can see in the patient’s abdomen. A special machine pumps heated chemo liquid into the abdomen. The chemo touches any cancer cells and tumors that are too small to see. After 90 minutes, the chemo is taken out.
HIPEC delivers chemotherapy directly to cancer cells in the abdomen. Heating the solution may also improve the absorption of chemotherapy drugs and destroy the microscopic cancer cells that can remain in the abdomen after surgery. The operation is performed under general anaesthesia and lasts for about 6-9 hours depending on its complexity.
HIPEC is a unique technique in which those abdominal malignancies or cancer cells are treated which were previously thought to be untreatable and were only offered palliative care. The indication of HIPEC is therefore very specific and it is meant for those cases of abdominal cancer in which the disease has spread only inside the abdomen and not through the blood or lymphatic.
How does it work?
Before HIPEC is administered, the surgeon–using standard surgical methods–will remove all visible tumors that can be removed throughout the peritoneal cavity. This is known as cytoreductive surgery. Following cytoreductive surgery, in the operative setting, the surgeon will administer HIPEC treatment.
Once all the visible tumors are removed within the abdomen, the heated, sterilized chemotherapy solution (with a temperature between 41-43 degrees celsius) is delivered to the abdomen for approximately 1 ½ hour to penetrate and destroy the remaining cancer cells. Thereafter, the solution is drained from the abdomen and incision is closed. The HIPEC procedure is designed to attempt to kill any remaining cancer cells reducing the normal side effects of chemotherapy.
Hipec procedure has two steps, Cytoreductive surgery followed by heated chemotherapy.
- Step 1: Cytoreductive surgery: The surgeon performs cytoreductive surgery to remove as much tumor growth as possible from the abdominal cavity. HIPEC without surgery is ineffective because the chemo drugs cannot penetrate deep into cancerous tumors.
- Step 2: Chemotherapy: BathMesothelioma doctors any remaining cancer cells with heated chemotherapy immediately after surgery to extend survival and prevent cancer recurrence. The usual chemotherapy drugs, including carboplatin, cisplatin, doxorubicin, gemcitabine and pemetrexed, have all been used for heated chemotherapy. Instead of injecting these drugs into your blood, doctors deliver them directly to the chest or abdomen.
How does the HIPEC machine work?
- Doctors insert catheters into the abdominal cavity and connect them to the perfusion system, which heats the chemotherapy solution and pumps it to and from the body.
- As the solution flows through the machine, a heating element raises it to between 105 and 109 F. Cancer cells start to die when heated to around 104 F, while normal cells can survive up to 111 F.
- A doctor massages the abdomen by hand to ensure the solution is fully mixed. This step helps the drugs reach the remaining cancer cells.
- The chemotherapy drugs flow between the patient and the perfusion system for about one hour.
- When the chemotherapy bath is finished, doctors drain the medicated solution from the body.
- The cavity is later rinsed with only a saline solution before the catheter is removed and the incision is closed.
- The entire procedure, including surgery and HIPEC, may take between six and 18 hours to complete because surgery times vary. The more cancer has spread within the abdomen, the longer surgery will take.
Advantages of HIPEC:
- 90% of the drug stays within the abdominal cavity, decreasing toxic effects on the rest of the body.
- This type of chemotherapy is best at killing cancer cells that are too small to be seen with the naked eye.
- Improves chemotherapy absorption and susceptibility of cancer cells.
- Enhances and concentrates chemotherapy in abdominal cavity locally.
- Reduces certain systemic side effects of chemotherapy.
- Chemotherapy delivered through HIPEC causes fewer side effects than intravenous chemotherapy. This is because the high concentrations of chemotherapy solution are unable to cross what is known as the peritoneal plasma barrier.
- Experts say that pairing surgery and HIPEC may be more beneficial than chemotherapy alone.
- Overall it has potential betterment of survival.
How does HIPEC differ from traditional chemotherapy?
There are a few types of cancers that are difficult to treat, particularly the ones located in the abdominal cavity. These cancers do not get killed with intravenous chemotherapy as with intraperitoneal chemotherapy. HIPEC experts say that the heat makes the chemotherapy more powerful in killing these cancer cells. The features of the machine are as follows:
- High doses of chemotherapy are possible.
- The chemotherapy is effectively carried out inside the abdominal cavity.
- The rest of the body has only minimal exposure to chemotherapy.
- Improves prognosis for the patient if done correctly.
- Reduces some side effects.
- Improves the drug absorption and susceptibility of the cancer cells in the abdominal cavity.
What are the side effects of HIPEC Surgery?
Patients must be prepared to receive nutrition through a feeding tube for about two weeks, while the digestive system recovers from the intense dose of chemotherapy. The possible risks and side effects of HIPEC surgery are:
- Chemotherapy can lower the number of red and white cells in the patient’s blood.
- Wound infections.
- Bowel obstruction.
- Fistula (a connection between the skin and intestines).
- Disruption of normal bowel motility (which reduces appetite).
- Need for more surgery.
- The combination of surgery and chemo can cause extreme tiredness and weight loss, which would usually stop 6–8 weeks after HIPEC.
Recovery After Hipec Surgery:
Recovery time after HIPEC surgery is different for each person, usually, it takes 10–12 weeks. Your treatment team will go over everything you need to know about the recovery process, including how to care for your incision wounds and encourage healing.
The most challenging aspect of recovery is fatigue. It will likely take two to three months until you begin to feel back to normal. Until then, it is important to stay active (within your limits) and maintain good nutrition.
Care at Treatment Possible
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