HIPEC Surgery in India: How it Works and Who Needs It

What is HIPEC Surgery?

HIPEC surgery is the short form of Hyperthermic Intraperitoneal Chemotherapy. It is a form of cancer therapy that is applied in a majority of cases with cancers within the abdominal cavity.

Here’s a simple breakdown:

What Happens in HIPEC Surgery?

First Step — Surgery (Cytoreductive Surgery)

• Surgery where excessive cancer mass is cut off from the abdomen as much as is possible.
• This part is known as cytoreductive surgery.

Second Step — Heated Chemotherapy (HIPEC)

• After surgeries, the liquid chemotherapy is inserted directly into the body of the abdomen.
• It’s warmed to about 41–43°C (105–109°F).
• In fact, it encompasses the warm chemo that takes about 60-90 minutes to surround the organs.
• The chemo is then removed and the cut made is sutured.

Treatment of HIPEC Surgery

Here’s a breakdown of HIPEC Surgery Treatment:

Cytoreductive Surgery (CRS)

• A part of cancerous tissue is surgically taken out from the abdominal cavity.
• This may involve taking out sections of the body organ for instance; intestine, ovary, spleen or even the lining of the abdominal cavity, peritoneum based on where the cancer is localized.

HIPEC Procedure

• After tumor mass is physically sensed, the abdominal cavity is then flooded with a warm chemotherapy solution that is normally ranging between 41 to 43 degrees Celcius.
• There is special equipment that circulates the chemo liquid in the abdomen for 60-90 minutes.
• Heat increases permeability of blood vessels which enhances the absorption of chemotherapy and its efficiency.
• Under the circulation time, the chemo solution in the abdomen is removed and the abdomen is washed.

Post-Surgery Care

• The patient is then brought to ICU or high-dependency unit for observation for the next few days.
• The recovery time may be as long as 4 to 8 weeks depend with the status of the patient and the intensity of the surgery done.
• During the recovery period, the patient takes intravenous fluids, antibiotics, as well as adequate analgesia.

Follow-Up Treatment

• The recovery exercise requires additional systemic chemotherapy (intravenous) for some patients as well.
• For this purpose, regular scans and check-ups with the doctor are conducted to check on the possibility of a relapse.

Symptoms leading to HIPEC Surgery

HIPEC surgery is not an initial procedure; it is done when some symptoms or situations indicate that cancer has spread internally within the abdominal cavity. HIPEC is administered depending on the overall prognosis symptoms, as well as the outcome of the scan.

These are among the symptoms that may make the doctors consider the HIPEC:

Abdominal Pain or Discomfort

• Cramping or pain and continuous bloating or the feeling of being full as a result of the growths impacting the lining of the abdomen.

Abdominal Swelling (Ascites)

• Accumulations of excess fluid in the abdomen (ascites) results into some symptoms like swelling, tightness and possibly breathlessness.
• Ascites usually manifest in cancers that have seeded the abdomen in particular the peritoneum which lies as the lining of this organ.

Digestive Problems

• Vomiting, nausea, constipation, and flatulence may result from the constrictive nature of tumor on the intestines.
• Sometimes even partial or complete bowel obstruction.

Unexplained Weight Loss

• Weight loss that occurs without any effort because of cancer that has a way of interfering with the digestion and metabolism.

Loss of Appetite and Early Fullness

• Satiety due to little food intake resulting from the effects of tumor compressing the stomach or intestine.

Fatigue and Weakness

• With the advancement in the cancer cell, there is something like energy loss due to the fight that the body has put up in order to contain the growth of the cancer.

Causes Leading to HIPEC

Below are the principle reasons (conditions or cancers) that may cause one to undergo HIPEC surgery:

Peritoneal Carcinomatosis

• Cause: that happens when the cancer displaces itself to the peritoneum which is being the lining of the abdominal cavity.

Pseudomyxoma Peritonei (PMP)

• Reason: This is a very uncommon disorder, which may be due to appendix cancer in which mucinous tumors (a semi-fluid) may spread within the abdomen.

Ovarian Cancer (Recurrent)

• Reason: It is applied when ovarian cancer relapses and is localized in the abdominal cavity; HIPEC is used as an adjuvant therapy in surgery for cancer residues.

Colon Cancer with Peritoneal Metastasis

• Reason: In case the colon cancer has metastasized to the peritoneum (lining of the abdomen), HIPEC can address these metastases.

Mesothelioma (Peritoneal)

• Reason: This is a very limited disease that hit the peritoneum and can be treated by HIPEC if the tumor is operable.

Stomach Cancer with Abdominal Spread

• Effect: In this case, HIPEC can be applied to address the peritoneal involvement as a part of the stomach cancer treatment.

Small Bowel Cancer

• Causes: Although it is a rather uncommon procedure, control of malignant appendix to peritoneal carcinomatosis through HIPEC is sometimes possible, if tumor has originated from the small intestine.

Best Surgeons for HIPEC Surgery (Treatment)

• Dr. Tapan Singh Chauhan
• Dr. Adarsh Chaudhary
• Dr. Vedant Kabra
• Dr. Harit Chaturvedi
• Dr. Vikram Pratap Singh

Top Hospitals for HIPEC Surgery in India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket
• Apollo Hospital, Delhi

HIPEC Surgery Diagnosis

Medical History and Symptoms

Some of these are the signs that a doctor examines during an investigation:

• Abdominal swelling (ascites)
• Persistent pain
• Bloating
• Digestive issues (nausea, vomiting, constipation)
• Unexplained weight loss
• They also examine the cancer history of the patient whether it is the colon, ovarian, appendix, stomach cancer, and so on.

Physical Examination

• A physical examination is then performed whereby the doctor inspects the abdomen for swelling, lump or even tenderness.

Imaging Tests
These are done in order to determine the extent of cancer in the abdomen:

• CT Scan (most common) — gives a detailed 3D image of tumors and fluid in the abdomen.
• MRI Scan – also used when there is a need for capturing detailed images of the soft tissues.
• PET Scan — may be performed to determine if the malignancy is confined to the abdominal area or if it has progressed to other parts of the body.
• Check for ascites or certain location of the tumor using ultrasound.

Blood Tests

• Possible blood tests would be cancer antigens such as CEA for colon cancer or CA 125 for ovarian cancer.
• In terms of routine blood tests to check on the body’s health overall, there are such things as liver function or kidney function.

Diagnostic Laparoscopy

• In case imaging is not conclusive, the doctors may carry out surgery on the affected organ without largely opening the body, which is called laparoscopy.
• They make small incisions, place the camera inside the belly and directly have a view of how cancer progresses.
• This helps in defining the PCI namely Peritoneal Cancer Index which defines how much of cancer is in the abdomen.
• In general, the lower the PCI score the higher the likelihood of success with HIPEC.

Assessing Overall Health

• It is an extensive surgery and thus; the doctors ensure that the patient has the ability to handle the stress placed on the heart, lungs, and kidney.
• They might do cardiac assessment, pulmonary function test or other tests with the help of some specialists.

HIPEC Surgery Facts and Solutions

HIPEC Surgery — Key Facts

HIPEC = Surgery + Heated Chemotherapy

• HIPEC stands for Hyperthermic Intraperitoneal Chemotherapy.
• Hot chemo is then introduced into the abdomen and doctors surgically remove noticeable tumors before circulating chemo into the abdomen to remove hidden cancerous cells.

It Targets Abdominal Cancers

• Specificity diseases such as colon, appendix, ovarian, stomach, and peritoneal mesothelioma cancers.

Heat Enhances Chemotherapy

• Raising the chemo to the temperature of 41 to 43 ° C (105 to 109°F), cancer cells become more susceptible while the healthy cells are not significantly affected.

One-Time Local Chemotherapy

• While the former is administered through intravenous infusion over weeks, the latter is done just once at the time of surgery and this is internally.

Long Surgery

• The cytoreductive surgery by itself can take about 3 to 5 hours, whereas HIPEC and staging may take extra 3 to 7 hours.
• That is a much specialised operation and cannot be performed at many hospitals, especially those of small size and those that are not oncological centres.

Better for Limited Disease

• Ordinarily useful if cancer has not spread to the lungs, brain, or bones as well as being localized in the abdomen.

Risky but Rewarding

• It includes high risks (risks are infections, bleeding and organ damage).
• But, it means that for many patients, it is an important opportunity in opposite direction, where they have more opportunity to survive or even to have chance that some forms of cancer can be cured.

Success Rate of HIPEC Surgery

Appendix Cancer (PMP)

60% to 90% (very high)

Colorectal Cancer (Peritoneal spread)

35% to 50%

Ovarian Cancer (advanced cases)

50% to 65% when done at recurrence

Stomach (Gastric) Cancer with peritoneal spread

20% to 30%

Why Choose GetWellGo for HIPEC Surgery?

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• Assistance during and after the course of treatment.
• Language Support
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• Case manager assigned to every patient to provide seamless support in and out of the hospital like appointment booking
• Local SIM Cards
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• Arranging Patient’s local food