HIPEC (Hyperthermic Intraperitoneal Chemotherapy)

Stomach (gastric) cancer may, in some patients, spread beyond the stomach to involve the peritoneum, the lining of the abdominal cavity. In such cases, imaging studies such as CT scans may show fluid or small deposits along the peritoneal surfaces. These findings, however, may not accurately represent the full extent of the disease or its clinical course.

In selected patients, a combined approach may be undertaken that includes cytoreductive surgery followed by Hyperthermic Intraperitoneal Chemotherapy (HIPEC). The objective is to remove visible tumour deposits and address residual microscopic disease within the abdominal cavity.

HIPEC is a treatment given during the course of surgery for certain types of abdominal cancer, including certain cases of stomach cancer with peritoneal involvement.

The process begins with cytoreductive surgery, where all visible tumor deposits in the abdominal cavity are removed as completely as possible. The extent of resection depends on the distribution of disease and the structures involved.

After this, a chemotherapy solution is instilled into the abdominal cavity and circulated for a defined period. The temperature of this chemotherapy solution is maintained at 41°C to 43°C.

The application of heat increases the effect of chemotherapy by enhancing tissue penetration and increasing its cytotoxicity. The chemotherapy is directly applied to the abdominal cavity; hence, it is possible to achieve high concentrations compared to systemic chemotherapy with relatively low systemic exposure.

Once the chemotherapy cycle is complete, it is drained, and the procedure is then completed.

HIPEC is not commonly used for all gastric cancer cases. It is considered in selected clinical settings, particularly when the disease involves the peritoneum and remains confined to the abdominal cavity.

Doctors may consider HIPEC in situations, such as:

• Peritoneal involvement identified during evaluation or at the time of surgery.
• Recurrence of gastric cancer limited to the abdominal cavity.
• Cases where the most visible tumour deposits can be surgically removed.
• Situations where control of disease within the abdomen is a treatment priority.

The purpose is to treat microscopic disease that cannot be seen during surgery but may contribute to recurrence.

Selection for HIPEC requires careful clinical assessment. Not all patients with peritoneal involvement are suitable for this approach.

Patients who may be considered include:

• Disease confined to the peritoneum, without spread to distant organs
• Situations where most of the tumour can be removed during surgery
• Patients who are able to tolerate a longer surgical procedure
• Individuals with satisfactory liver, kidney, and overall organ function
• Cases that have been reviewed by a multidisciplinary team at Gleneagles Hospitals

The decision is taken after correlating imaging findings, operative assessment, and the patient’s general clinical condition.

HIPEC is not suitable in all situations. In fact, in some situations, it might not be worth the risk. At Gleneagles Hospitals, this is reviewed carefully before planning the procedure.

It may not be considered in patients with:

• Disease that has spread beyond the abdominal cavity
• Medical conditions that make prolonged surgery unsafe
• Reduced functional capacity
• Significant impairment of vital organ function
• Extensive tumour involvement that cannot be adequately removed

In these situations, other treatment approaches are discussed depending on the overall clinical picture.

HIPEC is performed in an operating theatre equipped for complex oncological procedures, with support from surgical, anaesthesia, and critical care teams at Gleneagles Hospitals.

Before the procedure, patients undergo evaluation with imaging studies and required laboratory tests. The surgical plan is explained, and preparation instructions are given.

Patients are usually advised to:

• Keep fasting for a specified duration before surgery
• Inform the medical team about any medications being taken
• Follow the preoperative instructions provided

The first step is cytoreductive surgery, during which the abdominal cavity is examined, and visible tumour deposits are removed. The extent of this step depends on how widely the disease is distributed. The abdominal cavity is examined, and tumour deposits that can be identified are removed. Depending on the spread of the disease, this may involve the removal of involved tissues.

Once the surgical removal of visible disease is completed, the HIPEC phase is carried out. The chemotherapy solution is circulated in the abdominal cavity at a prescribed temperature for 60 to 90 minutes.

During this phase:

• The temperature of the solution is maintained within a defined range
• The solution is allowed to flow across the abdominal surfaces
• Vital parameters are continuously monitored

After completion of this step, the solution is removed, and the procedure is brought to an end.

After surgery, patients are kept under close observation. Initial monitoring may be required in a high-dependency or intensive care setting, depending on the clinical condition.

The rate of recovery is dependent on the degree of the procedure.

The postoperative care involves:

• Monitoring of the patient’s vital signs and organ functions
• Control of pain
• Gradual resumption of oral fluids
• Monitoring for possible complications
• Assistance in mobilization

The period of stay in the hospital depends on the rate of recovery.

HIPEC, together with major abdominal procedures, has its risks.

The risks may arise from the procedure or the chemotherapy itself.

Possible complications include:

• Infection
• Bleeding
• Delayed return of bowel function
• Fluid and electrolyte imbalance
• Generalised weakness and fatigue
• Local effects related to chemotherapy inside the abdominal cavity
• Organ-related complications in some patients

Close observation during and after the procedure helps in early recognition and management of any complications.

HIPEC is used to improve disease control within the abdominal cavity in selected patients.

Potential benefits include:

• Treatment of microscopic residual disease
• Higher local drug concentration compared to systemic therapy
• Limited systemic exposure to chemotherapy
• Combination with surgical removal of tumour
• Possible reduction in recurrence within the abdomen

The benefit varies depending on tumour type, disease extent, and completeness of cytoreduction.

Gleneagles Hospitals provides HIPEC as part of its cancer treatment services. The procedure is performed by surgical oncologists who specialise in gastrointestinal cancers.

Facilities include:

• Operating theatres equipped for complex procedures
• Multidisciplinary evaluation of each case
• Anaesthesia and critical care support
• Postoperative monitoring facilities
• Access to diagnostic and laboratory services
• Structured follow-up care

Each patient is evaluated individually before a treatment plan is finalised.

HIPEC is a treatment option considered in selected patients with gastric cancer involving the peritoneum. It involves the removal of visible disease by surgical means, as well as the application of heated chemotherapy inside the abdominal cavity to treat microscopic disease.

The method is recommended at Gleneagles Hospitals after thorough evaluation, depending on the condition of the patient and the disease.