Laparoscopic - Open HIPEC Surgery

Laparoscopic-Open HIPEC surgery is a combined surgical approach used for specific cancers that have spread within the abdominal cavity. It involves removing visible tumour deposits (cytoreductive surgery) and then circulating a heated chemotherapy solution directly inside the abdomen. This allows the medicine to reach cancer areas more directly than standard chemotherapy, which travels through the blood.

HIPEC can be considered when cancer is still limited to the abdominal lining and has not widely spread to distant organs. It is not a routine operation; the decision is made after thorough evaluation, scans, and discussions with the patient. Laparoscopic–open HIPEC surgery is offered at Gleneagles Hospitals within controlled surgical settings, where the team aims to balance tumour control with quality of life.

Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a treatment for cancers that have spread within the abdominal cavity. It is usually performed after cytoreductive surgery, a procedure in which the surgeon removes as much visible tumour as possible from the abdomen. In simple words, the goal is to reduce the overall tumor burden so that fewer cancer cells are left behind.

Step 1: Cytoreductive surgery
Visible tumour deposits on the abdominal lining, organs, or surfaces are removed as safely as possible. In some cases, affected portions of tissue, peritoneum, or segments of organs may need to be removed if involved.

Step 2: HIPEC (Hyperthermic Intraperitoneal Chemotherapy)
After the surgical removal, a heated chemotherapy solution is circulated inside the abdominal cavity. The temperature and concentration are controlled to help the medicine act on any microscopic cancer cells that cannot be seen or removed manually.

The “laparoscopic-open” format means the surgery may start through keyhole access to assess the disease and then shift to an open approach if required, depending on the findings.

This method may be used for cancers such as:

• Appendiceal tumours with peritoneal spread

• Ovarian cancer involving the peritoneum
• Colorectal cancer with peritoneal deposits

• Certain peritoneal surface malignancies, where the disease is confined to the abdomen

The aim is to improve local disease control and reduce recurrence within the abdomen.

The surgical plan is determined based on the extent of disease and overall health.

At Gleneagles Hospitals, this is a structured treatment plan rather than a single operation. Decisions are made following imaging, tumour board discussions, and patient counselling.

ions, and patient counselling.

Not all patients with abdominal cancer need HIPEC. It may be considered when:

• Cancer remains within the abdominal cavity rather than spreading to distant organs

• Scans show deposits on the peritoneum or omentum.
• Chemotherapy alone is unlikely to control the disease fully in that area.

• The patient’s general condition is suitable for a significant operation.

The goal is to reduce the risk of recurrence after removing visible disease.

This approach may not be recommended when:

• There is extensive disease outside the abdomen (lung, liver, bone spread)

• Severe heart or lung disease makes prolonged surgery unsafe
• Nutritional status or overall health would not tolerate a major operation

• The tumour burden is too high for meaningful cytoreduction

In these situations, the team may advise alternative treatment plans that are safer or more appropriate.

Before surgery, patients meet the surgical and oncology teams. Scans, tumour markers, and blood work are reviewed. Questions are encouraged, and expectations are discussed.

Before the Operation:

• Fasting instructions are shared in advance.

• Medications, especially blood thinners or chemotherapy-related drugs, are reviewed.

• Fitness for anaesthesia is confirmed.

During the Operation:

• Surgery is done under general anaesthesia.

• Laparoscopy may be used first to assess the spread and confirm the feasibility.
• Open cytoreductive surgery is performed to reduce the visible tumour
• Heated chemotherapy is circulated within the abdomen under monitored temperature and flow settings

• After the HIPEC phase, the solution is drained, and the abdomen is closed

Expected duration can vary significantly depending on the extent of the disease.

After the Surgery:

Recovery is different for each patient. It depends on how much tumour was removed and the person’s general health before surgery. In the first few days, some usual experiences can include:

• Feeling tired or washed out

• A sense of soreness or pressure in the abdomen
• Appetite is lower than usual at the start
• Drains or small tubes are in place to clear fluid for a short period

• Short walks and basic movement routines, as advised by the team

Food is restarted gradually. Light walking and simple breathing exercises are usually encouraged to help with recovery and prevent stiffness.

HIPEC is a major treatment and carries recognised medical risks, which may include:

• Infection

• Bleeding
• Reactions related to chemotherapy exposure inside the abdomen
• Temporary bowel changes
• Fluid and electrolyte imbalance

• Delayed recovery in those with limited reserve

These are monitored through regular checks, blood tests, and supportive care. The clinical team guides each step rather than rushing progression.

This treatment requires coordinated care between surgical oncology, medical oncology, anaesthesia, and intensive care support. At Gleneagles Hospitals:

• The procedure is performed by teams familiar with peritoneal surface malignancies

• Surgery, HIPEC delivery systems, and monitoring protocols follow structured clinical pathways.
• Anaesthesia and postoperative support are available throughout

• Patients are guided before surgery, supported during admission, and reviewed during follow-up.

Patients can request a consultation to determine whether HIPEC is suitable for their case and which alternatives are available.

Laparoscopic–Open HIPEC surgery is an advanced treatment for selected abdominal cancers. It focuses on reducing tumour burden and treating microscopic disease locally, where standard chemotherapy may not reach effectively. This is not a standard approach for everyone. The choice of treatment depends on what the scans show, the clinical examination, and the patient's overall health.

At Gleneagles Hospitals, the procedure is carried out in a supervised medical setting, and patients are given time to review their options and ask questions before they agree to proceed.