HIPEC: heated chemotherapy during surgery

HIPEC stands for hyperthermic intraperitoneal chemotherapy. It is a treatment given during major abdominal surgery for some cancers that have spread onto the lining of the abdomen, called the peritoneum. First, the surgeon removes all visible tumour deposits from the abdomen, an operation often called cytoreductive surgery, which can involve removing parts of several organs and the abdominal lining. Then, while the patient is still under anaesthetic, a heated chemotherapy solution is circulated through the abdominal cavity for a period of time, before being drained out. The idea is that the heat and the high local concentration of chemotherapy help destroy tiny cancer cells that cannot be seen or removed.

HIPEC is not a single standard treatment for every cancer. The evidence supporting it is stronger for some cancers and carefully selected patients, is uncertain or mixed for others, and does not support its use in many situations. It is a long, complex operation with significant risks, a hospital stay that may include intensive care, and a recovery that often takes weeks to months. It is also expensive. In India it is sometimes marketed aggressively, which can make it hard for families to judge whether it is appropriate. An honest assessment by an experienced multidisciplinary team, ideally including an independent second opinion, is essential before deciding. This page describes the procedure in general terms and cannot tell you whether it is right for you.

Surgery is the main part

HIPEC is only considered when surgeons believe all visible tumour can be removed. The surgery itself is the major undertaking.

Selection matters greatly

Whether HIPEC might help depends on cancer type, how widely it has spread, general fitness and other factors.

Experience matters

Outcomes and safety are closely linked to how experienced the surgical team and centre are.

It cannot tell you whether HIPEC is suitable for you or what results to expect. That depends on the type of cancer, how far it has spread within the abdomen, whether all visible disease can be removed, your fitness and your other treatments. Only a specialist team that has reviewed your scans and history can advise.

It also cannot give outcome figures. Results vary widely between cancers, patient groups and centres, and figures quoted without context can mislead. Ask your team to explain the evidence for your situation, including uncertainties.

Be cautious about marketing

Advertisements or claims that HIPEC works for any abdominal cancer are not supported by evidence.

Other options exist

Systemic chemotherapy, other surgery, clinical trials or supportive care may be alternatives. Ask about all of them.

Recovery affects the family

A long recovery means carers are needed for weeks. Plan support in advance.

Nutrition after surgery

Eating may be difficult for a while. Dietitian support is often needed.

Insurance and cost

Check insurance cover in writing before surgery, as costs can be substantial.

Clinical trials

For some cancers, HIPEC is being studied in trials. Ask whether a trial is relevant.

Emotional preparation

Major surgery and uncertainty are stressful. Counselling can help patients and families.

Follow-up

Regular scans and reviews after HIPEC are needed. Ask about the follow-up plan.

Life after HIPEC surgery

Recovery after cytoreductive surgery with HIPEC usually happens in stages. In hospital, the focus is on pain control, breathing exercises, getting out of bed, restarting eating and drinking, and watching for complications. After discharge, most people feel very tired for weeks, may have a reduced appetite or changes in bowel habit, and need help at home with daily tasks. Some have a temporary or permanent stoma. Gradually, energy and eating improve, and many people return to normal activities over a period of months. Regular follow-up visits and scans check recovery and whether the cancer has come back, and further chemotherapy may be recommended depending on the cancer.

Preparing for surgery

Before a major operation, improving fitness and nutrition can help recovery. Your team may suggest walking or breathing exercises, nutritional supplements, stopping smoking, controlling blood sugar and blood pressure, and arranging support at home. Preparing emotionally and practically, including time off work for carers, makes the recovery period easier for everyone.

Talking with your family

Share the information about HIPEC with close family before deciding, so they understand the risks, recovery and support that will be needed.

What to do next

If HIPEC is suggested, ask what evidence supports it for your cancer, how experienced the team is, what the risks, recovery and costs are, what alternatives exist, and seek an independent second opinion before deciding.