What is Hypothermic Intraperitoneal Chemotherapy (HIPEC) and How Does it Work?
0:57

Exclusive Content | Dr. Charles Conway: What is hyperthermic intraperitoneal chemotherapy?
What is Hypothermic Intraperitoneal Chemotherapy (HIPEC) and How Does it Work?

Exclusive Content

Dr. Charles Conway: What is hyperthermic intraperitoneal chemotherapy?

What Is HIPEC?

HIPEC, which stands for hyperthermic intraperitoneal chemotherapy, is the second part of a 2-step procedure to treat peritoneal mesothelioma. This process combines surgery with a warm chemo wash. 

After tumor-removing surgery, heated liquid chemo is applied directly, filling your belly. Also known as “hot chemo,” HIPEC aims to kill any mesothelioma cells that could remain after surgery.

Key Facts About HIPEC for Mesothelioma

  1. Hyperthermic means the chemo is heated above normal body temperature, usually between 106°F and 109°F.
  2. Intraperitoneal means chemo is applied directly to the abdominal cavity, unlike typical chemo, which is given via pills or an IV through your bloodstream.
  3. HIPEC uses a perfusion machine, which is like a gentle pump with a heater, warming up the chemo and slowly moving it through the inside of your belly like a warm bath.
  4. The chemo wash circulates for about 90 minutes, and about 90% of the chemo drugs stay in the abdomen rather than spreading throughout your body.
  5. During HIPEC, surgeons gently move your belly around so the warm chemo reaches everywhere, like swishing water in a bowl to wash all sides.

The goal of HIPEC is to treat peritoneal mesothelioma more effectively by delivering chemo directly where it’s needed most. This approach allows doctors to kill microscopic cancer cells left behind after surgery without affecting the entire body.

For people diagnosed with peritoneal mesothelioma, HIPEC is the most effective curative treatment currently available. Published 5-year survival rates range from approximately 36% to 50% depending on the stage of the patient’s cancer and overall health.

How Does HIPEC Surgery Work to Treat Mesothelioma?

HIPEC combines cytoreductive surgery with a heated chemotherapy solution to treat mesothelioma. The surgery removes visible tumors. The heated chemo helps kill cancer cells that may remain in the abdominal lining.

Heating the chemo causes blood vessels to expand and improves drug absorption. It also allows doctors to use higher doses than systemic or whole-body chemo without harming healthy cells throughout your body. The entire HIPEC process takes 6-8 hours to complete.

Heated Intraperitoneal chemotherapy (HIPEC) treatment for peritoneal mesothelioma
A HIPEC machine heats and delivers chemotherapy drugs.

Phase 1: Cytoreductive Surgery

Cytoreductive surgery is the first step of the HIPEC process. Surgeons remove all visible signs of peritoneal mesothelioma in your abdominal cavity. This may include parts of the lining around the organs in your abdomen called the peritoneum, as well as the spleen, bowel or other affected tissue. This process is called a peritonectomy.

Removing as much of the cancer as possible is key to improving outcomes. Surgeons aim to leave behind no visible tumor before moving on to HIPEC.

Phase 2: Chemotherapy Bath

Once surgeons remove the tumors, they begin HIPEC. They pump heated chemo drugs such as Platinol (cisplatin) or Mutamycin (mitomycin C) into your abdomen. While the chemo circulates, surgeons agitate the abdomen to help the solution reach every surface. This process is sometimes called “shake and bake” among surgeons and patients.

The chemo circulates for about 90 minutes using a perfusion machine that keeps the solution warm and gently moving. The entire HIPEC procedure, including the surgery and heated chemo circulation, usually takes about 6 to 8 hours.

Dr. Jason Foster, a surgical oncologist, compares the process to cleaning: “It’s like combining your power washer with the vacuum cleaner at home. Sometimes, you have to scrub the stain out, then go back over with the vacuum.” After the chemo drains, surgeons finish the procedure and close the incisions.

500+ SPECIALISTS AVAILABLE
Get to the Right Mesothelioma Cancer Center, Faster

Connect with top-rated mesothelioma specialists at a cancer center near you, who will personalize treatment options based on your diagnosis.

Find Your Center

What Can I Expect With HIPEC?

Peritoneal mesothelioma patients often have questions about what to expect before, during and after HIPEC. The process includes preparation, hospital recovery and at-home healing.

From Prep to HIPEC Recovery

  • Pre-surgery prep: May involve dietary changes, bloodwork and imaging tests.
  • Surgery time: HIPEC procedures typically take 6 to 8 hours.
  • Chemo circulation: Heated chemo circulates for about 90 minutes.
  • Hospital stay: Most patients stay in the hospital for 5 to 10 days.
  • Feeding support: A temporary nasogastric feeding tube can help with nutrition.
  • Activity timeline: Patients often return to normal routines in 1 to 3 months, though they should avoid heavy lifting for approximately 6 to 8 weeks.

Recovery is different for everyone. Some patients may feel fatigued, while others regain strength quickly. It’s important to follow your mesothelioma care team’s instructions closely.

Mesothelioma HIPEC Experience

Exclusive Content

Tamron Little: Peritoneal mesothelioma survivor shares her experience with the HIPEC procedure.

What Are the Benefits of HIPEC for Mesothelioma?

HIPEC offers many benefits for treating peritoneal mesothelioma. Because it targets the cancer site directly, it can improve survival while reducing whole-body side effects. Only 1 chemo session is needed during surgery, and it allows for higher drug doses in the abdominal cavity. Plus, systemic side effects are lower than with traditional chemo.

Dr. Edward Levine studied 46 patients with peritoneal mesothelioma who had cytoreductive surgery with HIPEC. Although physical and emotional well-being declined 3 months post-surgery, quality of life returned to baseline by 6 months and continued to improve over the next 18 months.

Success Rate of HIPEC for Mesothelioma

  • After HIPEC, patients with multicystic peritoneal mesothelioma had an average predicted disease-free interval of 11 years.
  • Some patients’ 5-year survival rates can reach 50% to 69%.
  • HIPEC helps most patients live for at least 5 years after diagnosis.
  • It’s most successful among younger, early-stage patients with fewer tumors.
  • Median survival ranges from 38 to 67 months, compared to approximately 31 months with other peritoneal mesothelioma treatments.
  • Surgery is successful in about 50% of peritoneal mesothelioma patients.
  • The 5-year progression-free survival rate for multicystic peritoneal mesothelioma patients after HIPEC is more than 80%.

The March 2025 report on the Indian Network for Development of Peritoneal Surface Oncology and Indian Society of Peritoneal Surface Malignancies conducted a consensus exercise. The report states: “Hundred percent panelists agreed that CRS-HIPEC should be the standard-of-care for newly diagnosed PeM [peritoneal mesothelioma] if the disease is completely resectable, and there is no contraindication to surgery.”

As Dr. Jonathan Foster explains, “Patients want to feel they have done everything they possibly can to fight this battle. Surgery with HIPEC is an important tool. It appears to be one therapy that can get people to this curative state.”

What Are the Survival Rates for HIPEC in Mesothelioma?

Cytoreductive surgery combined with HIPEC offers the most favorable survival outcomes currently available for people diagnosed with peritoneal mesothelioma. A 2026 study published in the European Journal of Surgical Oncology, conducted across cancer centers and universities in France, analyzed 924 patients treated for peritoneal mesothelioma over a 10-year period. Among patients whose tumors could be surgically removed, those treated with CRS-HIPEC had a 5-year survival rate of 84.6%.

A 2022 report from the Washington Cancer Institute found that approximately 80% of patients survived 5 years or more when they received additional chemotherapy after undergoing cytoreductive surgery with HIPEC. Outcomes are most favorable for patients with epithelioid histology, low Peritoneal Cancer Index scores and complete cytoreduction during surgery.

Time Frame Survival Rate
1-year survival Approximately 76% to 77%
3-year survival Approximately 55%
5-year survival Approximately 37% to 50%
10-year survival Up to approximately 45% (in select studies)

What Are the Side Effects and Risks of HIPEC for Mesothelioma?

The most common side effects of HIPEC surgery include nausea, vomiting, fatigue, abdominal pain and changes in bowel function. Not everyone experiences side effects and most people manage them well with proper care and treatment. Patients usually experience fewer systemic side effects than with intravenous chemo because it’s applied directly rather than being delivered through an IV.

Common Side Effects

  • Abdominal pain
  • Digestive changes
  • Fatigue
  • Low blood counts (myelosuppression)
  • Nausea or vomiting

More serious risks may include infection or bleeding. Rare but serious side effects may include damage to nearby organs, blood clots or a failure of a surgical connection between the intestines and other structures that creates what’s called an anastomotic leak. However, most people recover well with proper monitoring and care.

Mesothelioma HIPEC Recovery

Survivor Story

Tamron Little: How I felt after HIPEC surgery

I had a chance to go over the pamphlets and talk to someone that told me what to expect. I would say that it is a lot on your body, on your organs, especially your kidneys. And that is one of the, I would say, downfalls of it.

I was in the hospital after the surgery, I was in the hospital for a good week.

I was in there for a good week.

One of the things that I do remember that hurt, and that’s with any abdomen surgery, is the gas.

The gas. It hurts like the Dickens. I do remember going for walks in the hallways and things like that, and everything just hurting in my stomach region, just hurting.

For a long time, I carried a pillow and held it up against my stomach for months because they had a pillow on my stomach after surgery. I think one of the nurses, one of my mom’s friends, she said that will help me with the comfort. So everybody–

all the nurses put a pillow on my stomach every day. They changed it out. And when I walked, I had a pillow on my stomach. So it was painful.

First, my bowels took long to wake up.

Those took about two days to wake up. My kidneys, it took more than that. It was about a week. And that’s why I had to stay in the hospital that long because my kidneys were not waking up. So he gave me a day. And he said, they were going to do some things. So I believe they were pushing fluids, fluids, fluids.

And he told me, he said, Tamron, when I come in here tomorrow, if you’re creatinine level is what it is now, we’re going to have to take you downstairs, put you on dialysis. And I said, oh, no.

So I was really praying hard, praying hard, and called all the prayer warriors to pray that my kidneys will wake up. So the next day, he said, OK, I see some improvement.

And to this day, my creatinine level is elevated. So it’s higher than normal.

When I came home from the hospital, I was still in pain.

And like I said before, I still–

I carried a pillow everywhere I went and held it to my stomach.

I still had a lot of gas pain as well.

And that’s about it. I was nauseous, but I believe that it took me a couple of months to really bounce back.

Managing Side Effects of HIPEC for Peritoneal Mesothelioma

Managing side effects starts with preparation and continues through recovery. For many people with peritoneal mesothelioma, the most challenging aspect of HIPEC recovery is fatigue. It may take several months until you feel back to normal. Until then, staying active within your limits and maintaining a balanced diet to keep your energy levels up is essential.

Tips for Managing HIPEC Side Effects

  1. Stay hydrated and eat small meals.
  2. Use medications for nausea if prescribed.
  3. Take short walks as tolerated to build strength.
  4. Ask about support services like physical therapy.
  5. Rest and listen to your body during recovery.

If you develop any worsening side effects or conditions, call your mesothelioma doctor to discuss ways to manage or treat them. For example, a wound infection requires antibiotics and should be treated quickly. 

As peritoneal mesothelioma survivor Tamron Little shares, “The way I managed it was by taking my pain medication at the prescribed scheduled times. I also carried a small pillow around with me. I would place the pillow right on my stomach and just hold it there.”

Who Is Eligible for HIPEC Treatment?

HIPEC is most effective for people with peritoneal mesothelioma that hasn’t spread outside the abdomen. Mesothelioma doctors look at several factors to decide eligibility. Cancer must not extend beyond the abdominal cavity, meaning no distant metastasis exists. You should also be in good overall health with an acceptable performance status. You must also have no severe heart, kidney or lung issues.

Consulting a mesothelioma specialist is key. They can help determine if HIPEC is right and explain what to expect based on your cancer stage.

Tumor type also plays a role. People diagnosed with epithelioid peritoneal mesothelioma generally have the best outcomes from HIPEC, while doctors don’t typically recommend it for sarcomatoid or biphasic subtypes. Surgeons also use a staging system called the Peritoneal Cancer Index to measure how much cancer is present in the abdomen. Patients with lower scores are generally better candidates for HIPEC.

How to Receive HIPEC Treatment for Mesothelioma

HIPEC is offered to peritoneal mesothelioma patients at several top cancer centers across the United States. Treatment typically begins with a referral or consultation with a surgical oncologist.

Our Patient Advocates can help connect you with HIPEC specialists, schedule appointments and assist with insurance paperwork. Ask about which hospitals offer HIPEC for mesothelioma and how our team can support you.

The H. Lee Moffitt Cancer Center, mesothelioma treatment center
Moffitt Cancer Center

12902 Magnolia Drive, Tampa, FL 33612

Year Built: 1986
Number of Beds: 206 beds
Number of Physicians: 10

Mount Sinai Hospital
Mount Sinai Hospital

1 Gustave L. Levy Pl New York, NY 10029

Year Built: 1855
Number of Beds: 1,144 beds
Number of Physicians: 3

Ochsner Cancer Institute
Ochsner Medical Center

1514 Jefferson Hwy, Jefferson, LA 70121

Year Built: 1983
Number of Beds: 473 beds in main hospital
Number of Physicians: 4

Questions Our Patient Advocates Are Commonly Asked About HIPEC for Mesothelioma

Will I need chemotherapy after HIPEC?

Some patients may need additional chemotherapy after HIPEC based on cancer staging or if the disease returns. Systemic chemotherapy can help treat cancer cells that may be outside the abdominal cavity. Your doctor will determine the need based on follow-up imaging and lab results.

Can I receive HIPEC more than once?

HIPEC is usually done only once, but it may be repeated in select cases where the disease returns and the patient is healthy enough for more surgery. Repeat HIPEC procedures are more complex and depend on prior treatment history. A mesothelioma specialist can help assess if a second procedure is possible.

Where can I get HIPEC treatment?

Top cancer centers in the U.S., such as MD Anderson, UCSF and the University of Chicago, offer HIPEC for peritoneal mesothelioma. These hospitals have experienced surgical oncologists and dedicated care teams. Working with a center that specializes in mesothelioma is important for achieving the best results.

Is HIPEC painful?

Patients may experience pain or discomfort after surgery, but pain is usually well-controlled with medication. Most patients describe the discomfort as manageable and temporary. The care team works closely with patients to ease symptoms and support recovery.

What are the side effects of HIPEC surgery?

HIPEC’s side effects differ from both standard IV chemotherapy and other major abdominal surgeries. Because the chemo is delivered directly into the abdomen rather than through the bloodstream, patients typically avoid side effects like hair loss, chemo brain and widespread nausea that come with systemic treatment. Like other major abdominal surgeries, HIPEC carries a risk of serious complications in roughly 20 to 30% of patients, including pain, fatigue and infection, but most people manage these well with proper care and monitoring.

How long does HIPEC surgery take?

The combined cytoreductive surgery and HIPEC procedure typically takes 6 to 8 hours, with the heated chemotherapy portion circulating for about 90 minutes. Most patients stay in the hospital for 5 to 10 days. Full recovery takes 1 to 3 months, though doctors generally advise avoiding heavy lifting for 6 to 8 weeks.

Recommended Reading