HIPEC and Cytoreductive Surgery for Mesothelioma

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 103°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 heated solution circulates for about 90 minutes.
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.

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.

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 tumors are removed, surgeons begin HIPEC. They pump heated chemo drugs such as cisplatin or mitomycin C into your abdomen. The chemo circulates for about 90 minutes using a perfusion machine that keeps the solution warm and gently moving.

How HIPEC Works

1. Cytoreductive surgery: Removes all visible tumors from the abdominal cavity.
2. Chemo infusion: Pumps heated chemo into the abdomen using a perfusion machine.
3. Circulation: Circulates the chemo for about 90 minutes to coat all surfaces.
4. Drainage and flushing: Drains the chemo and flushes the area with a clean solution.
5. Closure: Surgeons close the incisions and begin post-op recovery.

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.

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 is drained, surgeons finish the procedure and begin closing the incisions.

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 6–8 hours.
• Chemo circulation: Heated chemo is circulated 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.

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.

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.
• 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 Side Effects and Risks of HIPEC for Mesothelioma?

Like any mesothelioma surgery, HIPEC has side effects. Not everyone experiences them, and most are manageable with proper care and treatment.

Common Side Effects

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

More serious risks are similar to those associated with other intensive surgeries. These risks may include infection, bleeding or damage to nearby organs. Peritoneal mesothelioma patients may also experience blood clots, and in rare cases, develop a fistula (abnormal connection) connecting the intestines to other structures. However, most people recover well with proper monitoring and care.

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 be 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.

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.

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.

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