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Call Now (855) 404-4592HIPEC surgery, also known as heated or hyperthermic intraperitoneal chemotherapy, combines chemotherapy and surgery to treat cancers in the abdomen. Doctors remove cancerous tumors from the abdominal cavity, then bathe the area with heated chemotherapy drugs to target any remaining cancer cells.
Watch: Dr. Charles Conway explains the HIPEC treatment for peritoneal mesothelioma patients.
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Cytoreduction is the term for surgery that removes tumor mass. HIPEC surgery adds a heated abdominal chemotherapy wash during the procedure, treating any areas too small for surgery alone.
Cytoreduction and HIPEC surgery is a multimodal treatment plan that has significantly improved survival for peritoneal mesothelioma patients.
The average survival was around six months before this therapy became available. Now half of patients who qualify for HIPEC surgery live longer than five years.
A 2018 International Journal of Hyperthermia study looked at the outcomes for 76 peritoneal mesothelioma patients treated with HIPEC surgery. Median disease-free survival was almost five years, and median overall survival was more than eight years.
Doctors developed the HIPEC procedure to improve the relatively poor results of traditional chemotherapy treatment. Although many patients respond well to unheated chemotherapy drugs, the effects are often short-lived.
The best way to learn more about the procedure and whether you qualify is to schedule a surgical consultation. During a consultation, you meet with the surgeon and members of the surgical team either virtually or in person. This gives you an opportunity to ask questions and address any concerns you may have with the team.
The surgical team will review all your medical records to determine if you qualify, and the surgeon will discuss the risks and benefits of surgery with you. You will learn more about the surgery, what preparation is required and how recovery will go.
Watch: Peritoneal mesothelioma survivor Tamron Little describes her experience during the HIPEC procedure.
Although the specific approach to HIPEC surgery can vary depending on the doctor and treatment center, the general concept is always the same. The procedure has two phases: Cytoreductive surgery followed by heated chemotherapy.
First, doctors perform 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. In some cases, complete removal of the tumors is impossible and patients may need to explore other treatment options.
Mesothelioma doctors target 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 the HIPEC Machine Works
The entire procedure, including surgery and HIPEC, may take between six and 18 hours to complete because surgery times vary. The more the cancer has spread within the abdomen, the longer surgery will take.
HIPEC surgery provides significant benefits to nearly all peritoneal mesothelioma patients eligible for the procedure. In a 2021 Oxford study of 40 patients with peritoneal mesothelioma, there were no deaths at the median duration follow-up at five years. The projected recurrence-free interval was more than 10 years.
Delivering heated chemotherapy throughout the abdomen prevents many side effects seen with systemic chemotherapy because the medication does not leave the abdominal cavity. The overall benefits of HIPEC translate to fewer complications and prolonged survival compared to patients who don’t have the procedure.
After HIPEC surgery, you should expect a recovery time of several months. 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.
Side Effects of HIPEC Surgery
Many HIPEC side effects correlate with common complications of other surgeries, including delayed wound healing, bleeding, sepsis and bowel obstruction. Eligibility requirements ensure you are a good candidate for HIPEC with a decreased risk for severe side effects.
HIPEC is an aggressive treatment and involves a lengthy surgery. To be eligible for HIPEC, patients must be in relatively good health to withstand the surgery and recovery period.
Contraindications of HIPEC can include severe chronic illnesses, heart disease and liver disease. A diagnosis with epithelial cell type improves the chances that HIPEC will be effective.
A 2021 research study by Dr. Paul Sugarbaker determined that age had the greatest impact on survival following a HIPEC procedure.
Peritoneal mesothelioma patients must:
Doctors look for patients who are otherwise healthy except for their cancer diagnosis. They conduct assessments to determine a patient’s overall health, which they call performance status.
The main reason this procedure is not offered as a standard treatment option at all mesothelioma cancer centers is because of the complexity of cytoreductive surgery and lack of familiarity with the HIPEC procedure and equipment.
Numerous studies show HIPEC surgery drastically improves life expectancy in about half of the peritoneal mesothelioma patients who undergo the procedure.
In a 2021 U.K. study, 40 patients underwent cytoreductive surgery with HIPEC for multicystic peritoneal mesothelioma. The average predicted disease-free intervals for women and men was 11 years, with a 5-year progression-free survival of more than 80%.
The study references a wide range of 7% to 60% for postoperative complications of HIPEC surgery. However, many of these reports originate from older studies involving aggressive and extensive peritoneal malignancy. The 10-year overall survival rate for patients in the Peritoneal Malignancy Institute study was nearly 100%.
In 2018, Dr. Paul Sugarbaker, who helped pioneer HIPEC surgery, published an update on the best treatment approaches for peritoneal mesothelioma. His report included survival results from a study he authored in 2017.
Sugarbaker’s study used cytoreductive surgery and HIPEC to treat peritoneal mesothelioma, with some patients also receiving one or two additional types of chemotherapy. Some patients received early postoperative intraperitoneal chemotherapy, commonly called EPIC. Other patients received EPIC plus adjuvant normothermic intraperitoneal chemotherapy, also called NIPEC, which is used long-term to prevent recurrence.
The five-year survival rates included:
Sugarbaker’s results indicate that long-term, nonheated intraperitoneal chemotherapy is an effective maintenance therapy that improves peritoneal mesothelioma survival.
In 2015, researchers from the Washington Cancer Institute’s Program in Peritoneal Surface Malignancy published results from a study on the survival outcomes of using HIPEC surgery a second time to treat recurrence.
Survival after a second HIPEC surgery was 4.5 years compared to 6.4 years after the first HIPEC surgery. These results suggest the HIPEC procedure is an effective second-line therapy for recurrent peritoneal mesothelioma.
In 2009, one of the largest multicenter studies on HIPEC for peritoneal mesothelioma patients published its findings. Dr. Tristan Yan and colleagues confirmed the treatment can significantly extend survival for select patients.
After follow-up with more than 400 patients, the researchers reported an overall median survival of 53 months — nearly 4.5 years. One patient survived for more than 19 years after the procedure.
Survival rates of one, three and five years were 81 percent, 60 percent and 47 percent, respectively.
For the right patients, HIPEC surgery can extend survival and provide a better quality of life.
However, the medical community has yet to reach an agreement on the best drug combination, chemotherapy temperature and exposure time for mesothelioma patients. As researchers uncover more about the technique, it is likely that survival outcomes will continue to improve.
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