What Happens During a HIPEC Operation? Step-by-Step Explained Simply
Medicine Made Simple Summary
A HIPEC operation can sound frightening because it involves major cancer surgery and heated chemotherapy. But when you understand the steps clearly, it becomes far less overwhelming. This article explains the entire HIPEC procedure in simple language—from the moment you enter the hospital, to how the surgery is done, to how heated chemotherapy is circulated inside the abdomen, to what happens immediately after the operation. By the end, you will know exactly what happens during a HIPEC procedure and why each step is important for treating abdominal cancers.
Understanding the Basics Before the Operation Begins
HIPEC stands for Hyperthermic Intraperitoneal Chemotherapy. It is always paired with a major surgery called cytoreductive surgery. This surgery removes all visible tumours inside the abdomen. HIPEC then targets the microscopic cancer cells left behind by washing the abdomen with heated chemotherapy. Because HIPEC stays inside the abdomen instead of entering the bloodstream, it attacks the cancer directly while reducing many side effects seen with regular chemotherapy. Suggested image: Simple illustration showing the abdomen with chemotherapy flowing inside.
The Hospital Admission and Pre-Surgery Preparation
Patients are usually admitted one day before surgery or on the same morning. Nurses check vital signs, hydration and fitness for anaesthesia. Doctors review scans and blood tests one final time. An anaesthetist explains how you will be put to sleep and monitored during the operation. You will be asked to fast for several hours before surgery. Some centres give bowel preparation depending on the organs involved. All of these steps ensure that you enter surgery safely and with a fully prepared medical team.
The Operating Room: What You Can Expect
Once you enter the operating room, the anaesthesia team places monitors on your chest, arms and fingers to track your heartbeat, oxygen levels and breathing. You are then given anaesthesia through a vein to make you sleep comfortably. The surgical team prepares the abdomen using sterile techniques. Because HIPEC is a long and detailed operation, the room has advanced equipment, warmers, infusion pumps and the HIPEC machine ready before the procedure begins. Suggested image: Operating room layout with HIPEC machine.
Step 1: Cytoreductive Surgery — Removing All Visible Tumour
The first and most important part of the HIPEC operation is cytoreduction. The surgeon opens the abdomen through an incision, usually from the chest area down to the pelvic region. This gives access to all abdominal organs. The surgeon then removes all visible cancer deposits. These may be on the peritoneum, intestines, liver surface, stomach, diaphragm, or pelvic organs. This step may take several hours. The more completely the surgeon removes visible tumour, the more effective HIPEC becomes. HIPEC cannot replace the removal of large tumour deposits. Its job is to attack microscopic disease.
How Surgeons Decide What to Remove
Surgeons examine the peritoneal surfaces and score them using the Peritoneal Cancer Index (PCI). This index helps assess how spread out the cancer is. Areas with tumour deposits are carefully cleaned, scraped, or surgically removed. Sometimes parts of organs such as the omentum, spleen, gallbladder or sections of the intestine may need to be removed if they carry cancer. Surgeons take great care to preserve healthy organ function whenever possible. Suggested image: PCI scoring diagram (simplified).
Step 2: Setting Up for HIPEC — Preparing the Abdomen
Once the visible tumour is removed, the surgical team prepares the abdomen for HIPEC. Flexible tubes called catheters are placed into the abdominal cavity. One or two tubes bring heated chemotherapy in. Another one or two tubes remove the fluid out. Temperature probes are placed to ensure the chemotherapy stays within the correct heat range, usually around forty-two degrees Celsius. The abdomen is then closed temporarily or held in place using specialised tools so that chemotherapy can circulate safely.
Step 3: The HIPEC Machine Is Activated
The chemotherapy drug, selected based on the type of cancer, is mixed and heated in the HIPEC machine. The machine ensures that the drug remains at a precise temperature. The heated chemotherapy is pumped into the abdomen and allowed to circulate. The machine maintains constant flow and temperature, while nurses and surgeons monitor everything closely. The heat makes the chemotherapy stronger and helps it penetrate tissues better.
Step 4: Circulating the Heated Chemotherapy Inside the Abdomen
The heated chemotherapy flows through the abdomen for around ninety minutes. During this time, the surgeon may gently move or rock the abdomen so the medicine touches all internal surfaces. The goal is to ensure that every area where cancer cells may remain receives direct treatment. Because the drug stays inside the abdominal cavity, higher doses can be used safely without affecting the rest of the body. Suggested image: Diagram showing inflow and outflow tubes circulating heated chemotherapy.
How Heated Chemotherapy Works on Cancer Cells
Heat weakens cancer cells. It opens their outer layer and makes them vulnerable. Heated chemotherapy enters them more easily and destroys them. Normal cells can tolerate heat better than cancer cells, which is why HIPEC works well inside the abdomen. The heat also improves blood flow inside tissues, helping the drug reach areas that are difficult to access during normal treatment.
Step 5: Removing the Chemotherapy After the Circulation Is Complete
After ninety minutes, the chemotherapy is drained from the abdomen through the outflow tube. The abdomen is rinsed with sterile fluid to remove any remaining medication. The tubes are removed. The surgeon then inspects the abdominal cavity one final time to ensure there is no bleeding and that everything is safe before closing the incision fully.
Step 6: Closing the Abdomen and Completing the Operation
The surgeon closes the abdominal incision in layers. Care is taken to ensure the closure is secure because the body will need several weeks to heal from such a major procedure. Drains may be placed to remove fluids during recovery. Once everything is complete, the patient is shifted to the recovery room.
Immediately After the Operation
When the patient wakes up, they are usually in an intensive care unit or a high-dependency ward for monitoring. The operation is lengthy, so the body needs time to stabilise. Nurses monitor breathing, blood pressure, urine output, pain control and temperature. Patients may have a tube in their nose called a nasogastric tube to help rest the stomach. Intravenous fluids provide hydration until the patient can drink.
Recovery in the First Few Days
Patients usually stay in the hospital for one to two weeks. The bowel takes time to start functioning again. Drinking water begins slowly, followed by liquids and then soft foods. Pain control is carefully managed. Walking starts as early as possible to reduce complications like clots or infection. Fatigue is common after such a major surgery. This is normal. Suggested image: Recovery timeline illustration.
How Doctors Monitor the Patient After HIPEC
Regular blood tests help doctors check kidney function, blood counts and electrolytes. The surgical team watches for signs of infection or slow healing. Nutritionists ensure the patient receives the right diet. The goal is to support the body through healing and gradually return strength.
Why HIPEC Must Be Done by Specialised Teams
HIPEC is one of the most complex cancer procedures. It requires surgeons trained in peritoneal cancer surgery, medical oncologists who understand heated chemotherapy, anaesthetists who manage long operations and ICU teams experienced in post-operative care. Hospitals must have the right equipment, including temperature-controlled HIPEC machines. This is why HIPEC is performed only in selected centres across India.
What Patients Should Know Before Agreeing to HIPEC
HIPEC is powerful but not suitable for all cancers. Only cancers inside the abdomen that can be completely removed benefit. Patients must understand that the operation is long, the recovery is slow and the results depend heavily on tumour removal. Discussing expectations, risks, benefits and alternatives with the doctor helps families make informed choices.
Conclusion
If you or your loved one has been advised HIPEC, schedule a consultation with a specialist trained in cytoreductive surgery and HIPEC. Understanding the steps clearly helps reduce fear and prepares you better for the journey. Ask your doctor about their experience, the expected recovery and whether the cancer is suitable for HIPEC. Early evaluation makes treatment safer and more effective.
