No, chemotherapy is typically administered intravenously and spreads throughout the body. HIPEC allows higher local drug concentrations with fewer systemic side effects.
Table of Contents 
Introduction
Cytoreductive Surgery (CRS) + HIPEC is a dual-therapy therapeutic approach that is beneficial, particularly in patients with advanced abdominal cancers, since it combines intense surgery with targeted chemotherapy. When colorectal cancer has spread to the lining of the abdominal cavity, a situation known as peritoneal carcinomatosis, standard intravenous chemotherapy may struggle to reach the surface-based tumours. This is an advanced method that entails a careful manual excision of all the visible tumours, which is immediately followed by the injection of the heated chemotherapy drugs into the abdomen.
By the end of this article, you will understand the specific mechanics of these procedures, the rigorous clinical standards required for them, and how Gleneagles Hospitals will incorporate this treatment as part of an overall oncology strategy to enhance long-term survival and quality of life.
The Two-Step Treatment Process
The CRS + HIPEC method is a highly coordinated procedure that occurs in two distinct phases during a single surgical session.
Phase 1: Cytoreductive Surgery (CRS)
The first goal is to leave no visible disease behind. The surgeon does a good investigation of the abdominal cavity, removing any visible tumours or malignant nodules. This can be done by excising part of the peritoneum or part of the organs to which the cancer has spread. This is a physically demanding phase that requires a high degree of precision to minimise the tumour burden to the lowest possible level prior to the start of the second phase.
Phase 2: HIPEC (Heated Intraperitoneal Chemotherapy Phase)
After the surgeon has completed the tumour excision, the surgeon begins the HIPEC phase while the patient remains in the operating theatre.
- Heating: The chemotherapy solution is heated to about 41-42 o C. Cancer cells are more vulnerable to heat, and the treatment can penetrate further into the tissues.
- Circulation: The solution is heated by dedicated pumps and circulated through the abdominal cavity, with a circulation time of 60-90 minutes.
- Direct Contact: This approach allows much higher doses of chemotherapy than would be safe to deliver through the veins, while minimising side effects in the rest of the body.
Role of CRS and HIPEC in Colorectal Cancer
CRS & HIPEC can be used to treat colorectal cancer that has metastasised into the abdominal cavity. This type of spread is known as peritoneal metastasis or peritoneal carcinomatosis. In the past, treatments for peritoneal metastasis were limited, and outcomes were poor. The normal systemic chemotherapy may not target the cancerous cells on the peritoneal surfaces.
CRS and HIPEC offer a more targeted approach. This combination therapy helps to improve local disease management by removing surface cancer and treating microscopic illness directly.
This treatment may help:
- Reduce tumour burden
- Improve symptom management
- Slow disease progression
- Prolong the life of selected patients.
However, this strategy is not applicable in all situations. It would require careful consideration to determine whether the gains would outweigh the losses.
The Surgical Journey at Gleneagles Hospitals
CRS + HIPEC is a significant medical procedure requiring a multidisciplinary team of surgical oncologists, anaesthesiologists, and intensive care specialists.
Pre-Surgical Assessment
The medical staff undergoes a lot of staging before the procedure. They involve a high-resolution PET-CT scan and may commonly involve diagnostic laparoscopy to determine the "Peritoneal Cancer Index" (PCI). The index assists the surgeon in determining the severity of the disease and can also be used to predict the likelihood of a successful complete resection.
Intra-Operative Care
The surgery is performed under general anaesthesia and can last anywhere from 6 to 12 hours. HIPEC machines, which measure the temperature and flow rate of chemotherapy, are installed in the surgical theatre. During the circulation stage, the surgical team remains in place to ensure that the solution flows throughout the entire abdominal cavity.
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Recovery and Post-Operative Management
CRS + HIPEC recovery is more vigorous than regular abdominal surgery because of the integration of significant surgery and heated chemotherapy.
- Hospital Stay: Patients spend an average of 10-14 days in the hospital. Close monitoring in the first few days is usually in a high-dependency unit.
- Digestive Recovery: Most of the time, the bowels take several days to return to normal function after exposure to the heated solution. Nutritional support is provided to patients via IV until they can tolerate liquids and soft foods.
- Physical Rehabilitation: Early movement is essential. Physical therapists work with patients to restore their strength and avoid complications such as pneumonia or blood clots.
Benefits and Outcomes
CRS + HIPEC provides various benefits in the case of correctly selected patients:
- Targeted Treatment: It delivers the highest possible dose of medicine exactly where the cancer cells reside.
- Improved Survival: In clinical trials, this combination was shown to improve survival compared with chemotherapy alone in specific forms of peritoneal spread.
- Symptom Relief: Stomach discomfort and pressure can be relieved depending on the extent to which the tumour and related fluid are eliminated.
Potential Risks and Safety Considerations
Considering the complicated nature of the process, patient safety at Gleneagles Hospitals is one of the issues that is closely monitored. Potential risks include:
- Infection or Delayed Healing: The intensive nature of the procedure and chemotherapy may slow down the natural healing process.
- Kidney Stress: The medical team will provide the patient with plenty of fluids in the process so that the kidneys will not be impaired in the process of administering the chemotherapy.
- Bone Marrow Suppression: A small dose of the drug can be injected into the blood, although it only temporarily decreases blood levels.
Why Choose Gleneagles Hospitals?
Gleneagles Hospitals offers specialised care for peritoneal surface malignancies, including:
- Experienced Surgical Oncologists: Doctors with specific training in the management of cytoreductive treatments.
- Advanced HIPEC Technology: State-of-the-art pump systems that ensure the safety and accuracy of temperature.
- Integrated Oncology Teams: Fluent coordination of the work of radiologists, surgeons and medical oncologists.
- Comprehensive Support: To help you in the healing process, rehabilitation experts, clinical dietitians, and pain management specialists will be with you.
Frequently Asked Questions
Q1. Is HIPEC the same as regular chemotherapy?
Q2. How long does the recovery take?
It takes three to six months of home-based healing after approximately two weeks in the hospital. At this stage, patients gradually regain their energy and appetite.
Q3. Does the heat during HIPEC damage healthy organs?
The temperature is strictly regulated (approximately 42 degree celsius). This temperature is sufficiently large to destroy tumor cells, which are more sensitive to heat, but is not excessive to the extent that healthy tissues will be able to endure the treatment.
Q4. Can CRS + HIPEC be used if the cancer has spread to the liver?
If there are a few small areas on the liver that may be removed, surgery may also be performed. However, alternative techniques are typically selected when the cancer has progressed to the lungs, bones, or deep into the liver.
Q5. Is everyone with advanced colorectal cancer a candidate for this?
No, the candidate screening process is really strict. The medical staff assesses the patient's overall health, the severity of the disease (PCI score), and the likelihood that all visible tumours may be safely removed.
