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Complication rates after HIPEC: what the evidence actually shows | CION Cancer Clinics
Complications after cytoreduction and HIPEC are common. In the studies NICE reviewed when it assessed the operation, serious complications were reported in between twelve and fifty-two per cent of patients, and death linked to the operation in between roughly one and six per cent. The range is wide because the operation varies so much from person to person. This page sets out what goes wrong, what lowers the risk, and what the figures cannot tell you. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MM
Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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The honest answer
How often do complications happen after HIPEC?
Often. In the studies NICE reviewed when it assessed this operation in 2010, serious complications were reported in between twelve and fifty-two per cent of patients, depending on the centre and how much surgery was done, and death linked to the operation in between roughly one and six per cent. This is one of the biggest operations in cancer surgery, and the figures reflect that.
Why the range is so wide
The operation is not one operation. A person who has one region of lining stripped is having a very different day from a person who has the lining stripped everywhere and the bowel, spleen and womb removed as well. The more that is done, the higher the risk. Centres that do the operation often report figures at the lower end of the range.
What the figures do not say
They do not say what will happen to you. They are dated, they come from mixed groups of patients, and they count complications of every kind, from a chest infection treated with antibiotics to a return to theatre. Your own risk depends on how much disease you have, which organs need to be removed, how fit you are, and the experience of the team. Ask your surgeon for their own centre's figures.
Nothing on this page is reassurance. It is what the published evidence says, so that you can weigh it with your team.The main ones
What are the complications that actually matter?
Some come from the surgery, some from the chemotherapy, and some from lying still for a long time.
A leak from a bowel join
The most serious. If a join between two cut ends of bowel fails to heal, bowel contents leak into the abdomen and cause a severe infection. It usually shows in the first week or two as fever, rising pain and a general worsening, and often needs another operation.
Bleeding
Stripping the lining leaves large raw surfaces, so bleeding during and after the operation is expected and blood transfusion is common. Bleeding that continues after the operation sometimes needs a return to theatre.
Infection and collections
Pockets of infected fluid can form inside the abdomen, and wounds can become infected. Most are treated with antibiotics and a drain placed through the skin under scan guidance rather than another operation.
Chest complications
A long operation, a large cut and stripping under the diaphragm make deep breathing painful. Chest infection and fluid around the lungs are common. Breathing exercises and getting out of bed early are the main protection.
Effects of the chemotherapy
The heated chemotherapy can lower the blood counts in the days after surgery, which raises infection risk, and can strain the kidneys. Both are watched with daily blood tests in the first week.
A bowel that stays asleep
After this much handling the bowel can take longer than usual to start working. You may need a tube through the nose and feeding through a vein for a while. It is common and it usually settles.
Not sure whether this applies to you?
Ask an oncologist
!
After you go home: what cannot wait
A fever, belly pain that is getting worse rather than better, vomiting that will not stop, a wound that leaks or opens, sudden breathlessness or chest pain, or a stoma that stops working and the belly swells. Go to the nearest emergency department the same day and say you have had cytoreductive surgery and HIPEC. Do not wait for the morning clinic, and do not take a painkiller and see.
What lowers the risk
What does a good centre do to keep the figures down?
Choose carefully
The single biggest protection is not operating on people who are unlikely to benefit. Careful scans, fitness testing and sometimes a keyhole look beforehand are how that is done.
Build you up first
Weight, protein intake and walking distance are improved before the operation where there is time. Smoking is stopped. Diabetes is brought under control.
Plan intensive care
You go to intensive care after the operation as a matter of routine, so that breathing, blood pressure, kidneys and blood counts are watched closely from the start.
Move and breathe early
Sitting out of bed, walking short distances and doing breathing exercises from the first days cut chest infections and clots. It is uncomfortable and it matters.
Watch for the leak
Daily examination and blood tests in the first two weeks are aimed at catching a bowel leak or collection early, when it can be treated with a drain rather than another operation.
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Commonly believed
Four things families believe about the risks
"A complication means the surgeon made a mistake."
Most complications after this operation happen with good surgery. Raw surfaces bleed, joins sometimes fail to heal, chests get infected after long anaesthesia. What separates centres is how quickly a problem is spotted and dealt with, not whether problems ever occur.
"If it is this risky, it cannot be worth doing."
That is exactly the question your team weighs, and the answer differs by cancer type and by person. For some cancers on the lining, this operation is the only treatment that changes the course of the disease. For others it is not offered because the risk is not justified. Ask which applies to you.
"Pick the centre that quotes the lowest risk."
A very low figure may mean careful selection and experience, or it may mean the centre counts differently or does few operations. Ask how many they do each year, how they count complications, and what happens when one occurs.
"Once he is home, the danger has passed."
Most serious problems show in hospital, but leaks, collections and clots can appear after discharge. That is why the warning signs above matter, and why you should know before you leave which number to call and which hospital to go to.
Being straight with you
What should you ask your surgeon about the risks?
Ask for the centre's own figures, not the published ones: how many of these operations they do each year, how many patients need a return to theatre, and how many die within a month of surgery. A team that does the operation regularly will know these numbers and will not mind being asked.
Ask what is most likely to go wrong for you
Your risk is shaped by your own case. Someone having bowel removed carries the risk of a leak; someone having the spleen removed carries a lifelong infection risk; someone with heart or lung disease carries more risk from the anaesthesia. Ask which of these is the concern in your case, and what the team will do about it.
What this page cannot tell you
It cannot tell you whether the operation is right for you, or what your own chance of a complication is. Published ranges are wide, dated and drawn from mixed groups of patients. They are a starting point for a conversation with a surgeon who has seen your scans, not a substitute for it.
If you have been given figures you do not understand, call the helpline. An oncologist will go through them with you and help you frame the questions for your surgeon.Questions we are asked
Common questions about the risks of HIPEC
What is the chance of dying from the operation?
In the studies NICE reviewed, death linked to the operation ranged from roughly one to six per cent, and experienced centres tend to report the lower end. That is higher than for most cancer operations, which is why selection is so careful. Ask your own centre for its figure and how it is counted.
What is the most dangerous complication?
A leak from a join in the bowel. Bowel contents escaping into the abdomen cause severe infection, and treating it often means another operation and sometimes a stoma. It usually shows in the first week or two, which is why you are examined and have blood tests every day in hospital.
Are the risks higher for older people?
Risk rises with poor fitness, heart and lung disease and weight loss, all of which are commoner with age, but age on its own is not the driver. A fit person in their seventies may carry less risk than a frail person in their fifties. The fitness tests exist to measure this rather than guess.
Does the chemotherapy add much risk?
It adds some. The heated drug can lower blood counts and strain the kidneys in the first days, and may slow the healing of bowel joins. Most of the risk, though, comes from the size of the surgery. The chemotherapy is the shorter and, in most people, the less dangerous half.
Can a complication mean the cancer was not fully removed?
No. Whether the visible cancer was cleared is recorded by the surgeon at the end of the operation, and a complication afterwards does not change that. It can delay further chemotherapy, which the team will factor into the plan. Ask for both pieces of information separately.
How will I know if a complication is starting at home?
Fever, pain that worsens instead of easing, vomiting, a leaking wound, breathlessness or a swollen belly with a stoma that stops working. Any of these on the same day. You should leave hospital with a number to call and a named hospital to go to, and it is fair to ask for both in writing.
Do second operations for complications cost extra?
Usually, and it is worth asking about before the first operation rather than after. Ask whether a return to theatre or extra intensive care days are included in any package. Aarogyasri, CGHS, ECHS and EHS are accepted, and most cashless insurers are empanelled; the helpline can check what your cover allows.
Where do these percentages come from?
From the studies reviewed by NICE, the body that assesses treatments for the health service in England, when it looked at this operation. They pool patients from several centres, with different cancers and different amounts of surgery. That is why the range is wide, and why your own centre's figures matter more.
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Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
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Dr. Vinay Mamidala
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Sources
- NICE — Cytoreduction surgery followed by hyperthermic intraoperative peritoneal chemotherapy for peritoneal carcinomatosis (IPG331)
- Cancer Research UK — Pseudomyxoma peritonei
- American Cancer Society — Cancer surgery
- National Cancer Institute — HIPEC (NCI Dictionary of Cancer Terms)
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
ICU and Hospital Stay After HIPECWhere most complications are caught and treatedIs HIPEC Worth It? What the Evidence ShowsWeighing the risk against what the operation can doChoosing a Centre for HIPECThe questions that tell you how experienced a team isComplications and Red FlagsWarning signs after any cancer operationHIPEC and Peritoneal Surface SurgeryEvery page in this guide
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Been given risk figures you do not understand?
Send us the surgeon's letter, or call the helpline. An oncologist will go through the figures with you and help you frame the questions for your team. One helpline serves every CION centre.