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Hyperthermic intraperitoneal chemotherapy (HIPEC)

Hyperthermic intraperitoneal chemotherapy (HIPEC) is a highly concentrated, heated chemotherapy treatment delivered directly to the abdomen during surgery. It results in a higher concentration and longer half-life of chemotherapeutic drugs in the peritoneal cavity as compared with IV administration

HIPEC delivers chemotherapy directly to the cancer cells in the abdomen unlike the conventional systemic chemotherapy which delivers chemotherapy via bloodstream. Heating the chemotherapy solution improves the chemotherapy drug absorption in the tumor cells and thus leads to more effective destruction of the cancer cells.

Indication for HIPEC surgery:

HIPEC is indicated for patients with resectable cancer with peritoneal metastasis without distant metastasis.

  1. Peritoneal Carcinomatosis (Gastrointestinal tumors like colorectal tumors, gastric cancers, mucinous appendiceal carcinoma and Ovarian cancer)
  2. Pseudomyxoma Peritonei
  3. Peritoneal Mesothelioma
  4. Peritoneal Sarcomatosis

Essential Components of Procedure:

  1. Cytoreductive Surgery (CRS):
    Before HIPEC, removal of all the visible disease with peritonectomy is performed.

  2. HIPEC:
    After CRS, a heated (41-42 degree Celsius), sterilized chemotherapy solution is delivered in the abdomen which penetrates and thus destroy the microscopic cancer cells in the abdomen. The duration of HIPEC procedure is 90 minutes.

Evaluation of Peritoneal Carcinomatosis:

  1. CECT abdomen/thorax :
    Contrast enhanced CT scan of chest and abdomen is performed to detect peritoneal cancer index (PCI)

  2. PET/CT scan :
    FDG PET scan helps in differentiating between true relapses and fibrotic scars caused due to previous treatments.

  3. Staging Laparoscopy :
    For cases having suspected peritoneal metastasis, staging laparoscopy is performed prior to surgery after giving anaesthesia to confirm the presence of peritoneal metastasis.

Benefits of HIPEC :

  1. Allows for a higher dose of chemotherapy
  2. Concentrates the chemotherapy within the abdomen
  3. Reduces body's overall exposure to the chemotherapy
  4. Improved absorption of chemotherapy and increased susceptibility of cancer cells
  5. Reduces side effects of chemotherapy

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