Hipec

HIPEC is a specialized treatment in which a heated chemotherapy solution is circulated within the abdominal cavity after surgery aimed at reducing visible tumour burden. It is not appropriate for every case of abdominal metastasis; patient selection, cancer type, and how much tumour can be removed surgically are all decisive factors. ^[1][2][3]

What is HIPEC?

HIPEC stands for “Hyperthermic Intraperitoneal Chemotherapy.” The basic approach is to first surgically remove visible tumour deposits in carefully selected patients with tumour spread inside the abdomen, and then circulate heated chemotherapy fluid within the abdominal cavity for a defined period. ^[1][2][4]

The aim is to expose microscopic tumour cells not visible to the surgeon to a high local concentration of chemotherapy. Heat is thought, under certain conditions, to enhance the effect of chemotherapy. Even so, HIPEC should not be viewed as an independent procedure performed on its own; it is usually planned together with cytoreductive surgery, and the success of this combination depends heavily on patient selection. ^[1][2][5]

In which situations is it considered?

HIPEC is most commonly evaluated in selected cancers that have spread to the peritoneum. Depending on the source, examples include colorectal cancer, appendix-origin tumours, some ovarian cancers, stomach cancer, and certain malignancies arising from the peritoneal surface. This does not mean that HIPEC is routine in all of these cancers. Cancer biology, disease burden, and surgical suitability remain decisive. ^[1][2][4]

One of the most important points is that visible tumour burden should be removable to a meaningful degree. In very extensive disease, poor general condition, or cases in which surgery cannot be performed safely, HIPEC may not be appropriate. For that reason, the decision is not made simply because imaging shows “spread within the abdomen”; assessment by an experienced multidisciplinary team is required. ^[1][2][5]

How is HIPEC performed?

The first step is usually cytoreductive surgery. The surgeon attempts to clear as much visible tumour as possible from inside the abdomen. Then, through inflow and outflow systems placed into the abdominal cavity, heated chemotherapy fluid is circulated. This fluid remains in the abdomen for a defined period and is then drained. The drug used, the temperature, and the duration vary according to disease type and the protocol of the centre. ^[1][2][3]

The goal of this approach is to deliver chemotherapy directly to the area where the disease is located at a high local concentration. That is one of the main differences from systemic chemotherapy. Even so, HIPEC should not be regarded as a completely “local and harmless” procedure; because it is part of major surgery, it requires comprehensive perioperative care. ^[1][2][5]

Why is it not suitable for everyone?

The main limitation of HIPEC is that it shows benefit only in a highly selected group of patients. Performance status, nutritional status, organ function, cancer type, extent of peritoneal involvement, and the presence of distant metastases are all considered. In some patients, the potential benefit may not outweigh the surgical risks. ^[1][2][5]

Centre experience also matters. CRS-HIPEC requires advanced surgery and complex oncological planning. That is why it is not performed routinely in every hospital. This does not mean the treatment is “mysterious,” but rather that it requires the right team and infrastructure. ^[1][3][5]

What benefits can it offer?

In appropriately selected patients, HIPEC may contribute to local control of peritoneal disease and may improve outcomes in some patient groups. Its major potential advantage is the intense exposure of microscopic residual tumour cells within the abdominal cavity to chemotherapy. The degree of benefit varies by tumour type and should not be presented as a guaranteed success. ^[1][2][4]

For that reason, the most appropriate way to discuss HIPEC is to balance hope with realism. In some patients it may offer meaningful benefit; in others, systemic therapy or palliative approaches may be more suitable. The most important determinant in clinical decision-making is not the theoretical attractiveness of the treatment, but the expected benefit-risk balance for that individual patient. ^[1][2][5]

What are the risks and complications?

Because HIPEC is usually performed together with major surgery, complications may be related not only to the chemotherapy but also to the operation itself. Infection, bleeding, bowel-related complications, delayed recovery, fluid and electrolyte imbalance, and the need for intensive care are among the possible issues. Toxicities related to the chemotherapy drug also vary according to the agent used. ^[1][2][5]

For that reason, HIPEC should not be considered a routine “add-on procedure.” Preoperative preparation, close postoperative monitoring, and complication management are at least as important as the procedure itself. In patients who are frail or nutritionally compromised, the risk-benefit balance must be weighed very carefully. ^[1][3][5]

What is recovery like?

Recovery depends on how extensive the surgery was. In some patients, the return of bowel movements, resumption of oral nutrition, and time to discharge may take longer than expected. Fatigue, appetite changes, and weakness are common in the early period. For that reason, recovery after HIPEC should not be thought of as comparable to recovery after a simple day-case procedure. ^[1][3][5]

During follow-up, the pathology result, the extent of surgery, the need for systemic therapy, and the imaging plan are reassessed. Some patients may require additional chemotherapy or close imaging surveillance afterward. It is important that the process be truly multidisciplinary rather than guided by a single specialty alone. ^[1][2][5]

When should a second opinion be considered?

When a major and highly selective treatment such as HIPEC is being discussed, obtaining a second opinion is often helpful. Especially if there is uncertainty about cancer type, extent of peritoneal involvement, or systemic treatment options, consultation at an experienced centre may clarify decision-making. In most situations, this is not a waste of time but a step toward better planning. ^[1][2][5]

HIPEC can be an important option for some patients, but it is not the standard approach for all peritoneal metastases. A comprehensive evaluation is required to determine suitability. The safest path is to obtain personalized advice from a team in which surgical oncology, medical oncology, pathology, and radiology work together. ^[1][2][5]