“What is HIPEC?”

Arthur Rettig, MD, was a PMP Pal and a physician, who regularly answered Pals’ questions. Sadly, he passed away from this rare disease in 2023. Here’s his take on HIPEC:

“Either you are a patient, relative, or friend of a patient who has been diagnosed with cancer of the appendix which has spread within the abdomen. You have been told that you need surgery and that HIPEC will be a part of the operation. Many small tumors may be spread throughout the abdomen and on the surface of organs in the abdomen. They produce a mucous-like substance that is usually referred to as “mucin.” HIPEC was developed to help treat this condition.

“The HIPEC procedure is usually done towards the end of the operation and involves circulating a chemotherapeutic agent dissolved in a solution into the patient’s abdomen through the incision site.  HIPEC has been proven to be more effective than standard chemotherapy and is administered by infusion through a vein. Higher levels of chemotherapeutic agents can be established via HIPEC than conventional chemotherapy. This is possible since the lining of the abdomen, the peritoneum, is a large absorptive surface.

“HIPEC consists of placing perfusion catheters into the abdomen (the peritoneal cavity), which are very similar to those used in heart surgery. There is an inflow catheter and an outflow catheter. Heated or hyperthermic chemotherapy, (the “H” in HIPEC) is pumped into the abdomen through the inflow catheter and exits through the outflow catheter. The operating table is then vibrated so that the fluid can circulate throughout the abdomen. The chemotherapeutic agent (the C in HIPEC) is dissolved in the fluid. The fluid is directed into the peritoneal cavity (the PE in HIPEC). The fluid is heated to 107 degrees Fahrenheit to achieve greater penetration of the chemotherapeutic agent. This part of the operative procedure may take about one and a half hours.

“HIPEC is usually done along with CRS, which stands for “cytoreductive surgery”. After the patient is anesthetized, this part of the operation proceeds first and consists of the removal of the sites of the tumor and mucin and may involve the removal of some internal solid organs, such as the gall bladder, spleen, and part of the intestine.

“After the CRS is completed, the perfusion tubes for HIPEC are placed into the patient’s abdomen and the incision is closed. Once the HIPEC perfusion is complete, the abdomen is re-opened to be certain that nothing is amiss and then the abdomen is closed. The length of the surgery is variable, depending on the amount of dissection done during the CRS. A patient’s recovery time in the hospital is variable. It depends in part on the amount of dissection done during the CRS. The more drastic the organ removal and the more intestinal work done, the longer the recovery period.

“I hope this helps you to understand both HIPEC and CRS. In another article, I will discuss what you can expect when you go home and what you can do to hasten your recovery.”