Cytoreductive Surgery And HIPEC Treatment Procedure

Cytoreductive Surgery

Cytoreductive surgery is a form of surgery that targets reducing the amount of a tumor present in the body, often used in situations where total removal may not be an option for more advanced tumors. This allows for better responses to various other forms of therapy.

HIPEC Treatment

HIPEC is a chemotherapy technique employed after performing cytoreductive surgery on patients diagnosed with cancer that's spread to their abdomen and organs.

What Is HIPEC?

After cancer-generating cells have been surgically removed, the abdomen is bathed with a chemotherapy solution that's been warmed to destroy any remaining tiny cancerous growths. The chemotherapy is delivered straight into the abdomen rather than being administered into a vein.

HIPEC Surgery

HIPEC surgery involves first removing cancerous tumors through CRS and then administers heated chemotherapy intraoperatively during HIPEC. It's a powerful therapy for cancers that have metastasized to the internal lining of the abdomen.

What is Cytoreductive Surgery HIPEC?

Cytoreductive Surgery (CRS):

• Cytoreductive surgery is performed first during a HIPEC treatment.
• The surgeon removes every observable cancer outgrowth in the abdomen.

It’s possible that the following organs may be taken out during the operation:

• Omentum (omentumectomy)
• Either the small intestine or a part of the stomach may also be removed during the operation.
• Spleen (splenectomy)
• Gallbladder
• The uterus and/or both ovaries are removed in women who undergo the procedure.
• Parts of the peritoneum (peritonectomy)

HIPEC Procedure:

• Following CRS, the abdomen is infused with chemotherapy at a temperature between 106°F and 110°F.
• The heated chemotherapy stays in the abdomen for either 1 or 2 hours.
• It aims to destroy minute cancer cells that were left behind after surgery.

Hyperthermic Intraperitoneal Chemotherapy

Hyperthermic Intraperitoneal Chemotherapy is a treatment that involves delivering heated chemotherapy directly into the peritoneum, combined with tumor removing surgery, to eradicate widespread peritoneal cancer.

HIPEC Procedure

HIPEC is a modern cancer treatment given immediately after surgery that removes all visible tumors from the abdomen. Heated chemotherapy is infused directly into the abdominal area to target and destroy any residual tumor cells.

A Step-by-Step Description of the HIPEC Treatment

Pre-operative Preparation

• Imaging tests: CT, MRI, PET-CT
• Laboratory exams of blood and key cancer markers such as CA-125 and CEA are performed.
• Testing of how well the patient’s heart, lungs and kidneys work.
• Assessments of nutrition and readiness for major abdominal operations also determine if the patient is an appropriate candidate for HIPEC.

Cytoreductive Surgery (CRS)

• Tumors that can be seen within the abdomen are all taken out.

May involve resection of:

• Omentum
• Peritoneum
• Colon or small intestine
• Spleen, gallbladder and for women, uterus and ovaries if involved.

HIPEC Administration

• Catheters are then placed inside the abdomen to allow for circulatory chemotherapy.
• The cancer medications are warmed to between 105.8–109.4 degrees Fahrenheit with the help of advanced equipment.
• Polystyrol membranes diffuse the heated chemo throughout the peritoneal cavity.
• The temperature and rate of the perfused chemo drugs are closely supervised throughout the procedure.
• The surgeon moves the organs around to help the chemotherapy drugs reach all affected areas evenly.

Common HIPEC Drugs Used

• Mitomycin-C (common for colon cancer)
• Cisplatin is usually administered for cases of ovarian and gastric cancers.
• Oxaliplatin
• Doxorubicin
• Drugs are chosen based on the specific cancer and the condition of the individual.

Completion

• The chemotherapy solution is drained.
• A saline solution is used to clean out any remaining chemotherapy drugs from the abdominal cavity.
• The wound is carefully stitched and the patient is shifted to the ICU or recovery unit.

Factors Affecting HIPEC Treatment Cost

The price of HIPEC treatment fluctuates greatly due to a number of medical, hospital-based and patient considerations. Here’s a comprehensive breakdown:

• Type & Stage of Cancer
• Extent of Surgery Required (CRS)
• Hospital/Center of Treatment
• Surgeon & Onco-team Expertise
• Type of Chemotherapy Drug Used
• Duration of Hospitalization
• Supportive Care & Diagnostics

HIPEC Recovery Time

Recovering from HIPEC along with CRS surgery can be extensive since it includes major abdominal surgery and administered chemotherapy. The exact recovery duration may depend on the type of cancer, the extent of surgery needed and a patient’s overall health.

Typical HIPEC Recovery Timeline

Immediately After Surgery (First 1–5 Days)

• ICU stay: 1–3 days for close monitoring
• Effective pain control using IV drips or epidural anesthesia.
• Physiotherapists start working with patients to improve breathing and overall mobility shortly after surgery.
• No food by mouth initially; IV fluids and nutrition provided

In-Hospital Recovery (1–3 Weeks)

• Moved to a regular hospital room as health improves.
• Sips to start and slow introduction of soft food as tolerated.
• Bowel movement return is monitored
• Incision care and infection prevention
• Start moving around (by walking and sitting) as soon as it is acceptable after the operation.

Post-Discharge (Weeks 3–6)

• Home rest with light activity
• Feeling tired, weak and having a lack of appetite are often experienced during recovery.
• Frequent visits for monitoring blood tests and the progression of healing.
• Caring for your wound, managing pain and receiving proper nutrition remain important in the recovery process.

Full Recovery (6–12 Weeks or More)

• Normal bowel function returns
• Restarting the activities people were involved in and eventually going back to work.
• Nutritional rehabilitation and physical strengthening
• Emotional and psychological healing can gradually occur as time passes.

HIPEC Side Effects

Digestive system

• Nausea
• Vomiting
• Diarrhea
• Bloating
• Delayed bowel recovery

General body    

• Fatigue
• Weakness
• Weight loss
• Muscle wasting

Wound/skin

• Surgical site pain
• Infection
• Poor wound healing

Kidneys

• Temporary or, rarely, long-term kidney dysfunction

Liver

• Mild to moderate liver enzyme elevation

Blood

• Low white blood cells
• Anemia
• Platelet issues

Immune system

• Increased risk of infection post-surgery

Reproductive system

• Temporary or permanent infertility (especially in women)

Lungs/heart

• Rare complications due to anaesthesia or prolonged bed rest (e.g., pneumonia, clots)

HIPEC for Ovarian Cancer

HIPEC chemotherapy is becoming an increasingly valuable treatment option for patients with more advanced or recurrent ovarian cancer whose disease involves the abdominal lining. HIPEC is often done as part of a procedure known as cytoreductive surgery that helps improves the chances of success.

What Is HIPEC in Ovarian Cancer?

• Following surgical removal of all visible tumors, the inside of the abdomen is exposed to heated chemotherapy of 41–43°C for 60–90 minutes.
• This helps destroy any remaining cancer cells that may have been missed.
• Applying heat enhances the ability of the chemo to reach and destroy cancer cells deep inside the body, also reducing the risk of side effects elsewhere.

Common Chemo Drugs Used in HIPEC for Ovarian Cancer

• Cisplatin (most commonly used)
• Other drugs such as Paclitaxel or Doxorubicin may be added as well.

Advantages of HIPEC for treating ovarian cancer

• Gets rid of ovarian cancer cells that survive during surgery.
• Lower chance of peritoneal recurrence
• Fewer body-wide adverse effects compared to IV chemotherapy
• Can allow patients to complete fewer rounds of IV chemo.