Some patients suffering from advanced abdominal cancers may not achieve the desired outcomes with standard treatments. Treatment becomes more complex when the disease spreads to the lining of the abdominal cavity. The thin, protective membrane that lines the inside of the abdomen and covers most of the organs( stomach, intestines, and liver) is known as the peritoneum. At this stage, routine chemotherapy given by an oncologist through the bloodstream may not always reach the affected area effectively.
This is where a revolutionary procedure steps in. Hyperthermic intraperitoneal chemotherapy (HIPEC) is a specialised treatment that combines precise surgery with warm chemotherapy medicine delivered inside the abdomen. This focused approach helps to eradicate targeted microscopic cancer cells with utmost precision.
What is HIPEC?
To put it simply, HIPEC is a concentrated, heated chemotherapy treatment. It is delivered directly to the abdomen during surgery. Unlike traditional chemotherapy that travels through the entire bloodstream, HIPEC chemotherapy targets the specific area where the cancer exists.
The procedure is performed immediately after a surgeon removes all visible tumours from the abdomen.
Instead of closing the abdomen and sending them home, the surgical team circulates a heated (usually 41–43°C / 105.8–109.4°F) anti-cancer drug inside the abdominal cavity. This procedure usually takes about 60 to 90 minutes, depending on protocol and cancer type.
The "hyperthermic" (heated) element is crucial because the heat makes the cancer cells more susceptible to the chemotherapy and helps destroy them more effectively. Direct intraperitoneal delivery allows higher local drug concentration at the targeted site with relatively lower systemic toxicity compared to IV chemotherapy.
Precisely, the temperature mechanism in HIPEC works through:
- Increased chemotherapy penetration into tissues
- Direct heat-induced cancer cell damage
- Impaired DNA repair in tumour cells
Why It's Different from Traditional Chemotherapy
In short, traditional chemotherapy treats the body as a whole. HIPEC chemotherapy treats the abdomen with precision. For convenient reference, here is a comparison between systemic chemotherapy and HIPEC. Let's understand the process in detail.
Traditional chemotherapy is systemic and affects healthy tissues
The medication travels through the bloodstream and circulates throughout the entire body. While this approach can treat cancer cells in many locations, it also exposes healthy tissues to the drug. That is why patients often experience broader side effects.
HIPEC Ensures Precision With Localised Drug Concentration
HIPEC chemotherapy works differently. Instead of moving through the whole body, hyperthermic intraperitoneal chemotherapy is precisely delivered directly into the abdominal cavity during surgery. This allows surgeons to concentrate the medication exactly where the tumour cells are most likely to remain.
Because the drug is placed inside the abdomen rather than infused through a vein, much higher local concentrations can be used safely. At the same time, systemic absorption remains comparatively limited. This targeted strategy helps increase effectiveness at the tumour site while reducing widespread exposure to the rest of the body.
Comparison between traditional Chemotherapy and HIPEC:
How the HIPEC Procedure Works
HIPEC is a highly specialised procedure performed in select centres by an experienced multidisciplinary team, including surgical oncologists, anaesthesiologists, perfusion specialists, and critical care staff. It essentially combines two coordinated stages, as mentioned below, during the same operation.
Step 1: Cytoreductive Surgery
The procedure begins with cytoreductive surgery. First, the surgeon carefully removes all visible tumour deposits from the peritoneal surfaces and affected organs in the abdominal lining. This may involve peritonectomy procedures and, in some cases, removal of involved structures such as portions of the intestine, spleen, gallbladder, or other organs.
The goal is to complete macroscopic tumour removal, often referred to as achieving a complete cytoreduction. HIPEC is most effective when little to no microscopic disease, or ideally, no visible disease remains. This part can take several hours, as the surgeon must carefully inspect and clean the organs within the abdomen.
Step 2: The Chemotherapy Bath
Once cytoreduction is completed and the visible tumours are gone, the HIPEC chemotherapy phase begins. The surgeon inserts tubes into the abdomen and closes the temporary incision while the patient remains under anaesthesia. A machine pumps the heated chemotherapy solution through these tubes, bathing the internal organs.
The temperature is usually maintained between 41–43°C / 105.8–109.4°F, as mentioned above. Special inflow and outflow catheters are placed within the abdominal cavity. The abdomen may be temporarily closed (closed technique) or covered with a sterile plastic sheet (open or "coliseum" technique). The procedure mainly depends on the centre's protocol. The perfusion generally lasts 60 to 90 minutes, although timing may vary based on tumour type and institutional protocol.
The surgical team may gently reposition or tilt the operating table to ensure even distribution of the chemotherapy solution across all peritoneal surfaces. After the cycle is complete, the surgeon drains the solution and rinses the abdomen before closing the incision.
Who Can Benefit from HIPEC?
Not every cancer patient is eligible for this procedure. HIPEC is carefully recommended for individuals whose cancers have originated in or spread to the peritoneal cavity (the thin lining inside the abdomen). The key factor is that the disease remains largely confined to the abdominal lining and can be surgically removed.
Therefore, patient selection for the HIPEC surgical procedure is critical. Oncosurgeons evaluate the extent of tumour spread, overall health status, organ function, and the likelihood of achieving complete cytoreduction. HIPEC can offer improved local disease control and, in some cases, extended survival outcomes when administered in the right clinical setting.
Types of Cancers Treated
HIPEC surgery for cancer treatment is most commonly used for:
Appendiceal Cancer: Particularly those causing pseudomyxoma peritonei.
Colorectal Cancer: When the cancer has spread only to the peritoneum and not to distant organs like the liver or lungs.
Pseudomyxoma peritonei: a slow-growing borderline malignant disease in the abdominal cavity, often referred to as "jelly belly".
Mesothelioma: Specifically, malignant peritoneal mesothelioma.
Ovarian Cancer: In select cases of recurrent disease.
Doctors evaluate the extent of tumour spread, overall health status, organ function, and the likelihood of achieving complete cytoreduction to determine eligibility. First, they perform various extensive scans and sometimes a diagnostic laparoscopy. The HIPEC cancer treatment is most effective when the disease is limited to the abdomen and the patient is strong enough to withstand a long, major operation.
The Benefits of HIPEC
A common question that arises after understanding the HIPEC procedure is Why do oncologists choose this aggressive path over standard treatments? The benefits are distinct and significant.
High Concentration, Low Systemic Exposure
Because the drug is placed directly into the abdomen, the concentration of the chemotherapy can be up to 100 times higher than what is used in IV treatment. This potent dose kills the microscopic residual cancer cells that surgery might have missed.
Crucially, very little of the drug leaks into the rest of the body. This means HIPEC chemotherapy causes fewer side effects in organs like the bone marrow, kidneys, and heart compared to traditional systemic chemo.
Improved Survival Rates
For cancers like pseudomyxoma peritonei and mesothelioma, studies have shown that HIPEC can significantly extend life expectancy and, in some cases, offer a potential cure where palliative care was once the only option.
Risks and HIPEC Surgery Complications
While the benefits are promising, this is a major surgery and carries significant risks. It requires a long incision and a lengthy anaesthetic time, often 8 to 14 hours. Patients must be aware of the potential HIPEC surgery complications.
Common Short-Term Side Effects
Common risks associated with any major surgery apply here, such as infection, bleeding, or blood clots in the legs. However, there are specific risks related to the procedure itself. The heat and the chemo can cause temporary inflammation of the bowel, leading to a longer recovery of bowel function.
Rare but Serious Complications
Other potential HIPEC surgery complications include leakage from the bowel connections (anastomotic leaks), low white blood cell counts, or temporary kidney issues. Recovery in the hospital can take 10 to 14 days, and a full return to normal activities might take three months or more. However, in expert hands, the incidence of severe complications is significantly reduced.
When to Consult an Oncologist
Individuals experiencing any of the following signs or symptoms for an extended time should immediately consult with an experienced oncologist in Dubai for faster recovery.
Persistent abdominal symptoms: Individuals experiencing ongoing bloating, unexplained pain, or increasing abdominal discomfort.
Fluid buildup in the abdomen (ascites): Persons observing recurrent abdominal swelling should consult a specialist for an accurate diagnosis.
Diagnosis of abdominal or pelvic cancer: For any discomfort, early consultation with specialists helps explore advanced treatment options.
Cancer that has spread within the abdomen: If imaging shows peritoneal involvement, patients should consult an oncologist, and they will assess suitability for targeted approaches.
Worsening symptoms despite treatment: If current therapy is not providing expected results, patients should consult a specialist for an in-depth diagnosis to detect the actual medical condition.
Early expert guidance improves clarity, confidence, and timely decision-making. Moreover, it significantly increases the chances of faster and complete recovery.
Finding the Best Oncologist in Dubai
The HIPEC procedure is highly technical and requires a team with specific expertise. It is not performed in every hospital. Patients should seek a facility that performs this surgery regularly and with high success rates.
When looking for help, it is essential to consult an experienced oncologist in Dubai who specialises in peritoneal surface malignancies. The surgeon's skill in removing the tumours (cytoreduction) is the biggest predictor of success.
Therefore, patients should choose the best cancer hospital in Dubai that offers a comprehensive HIPEC programme. Aster Hospitals have a dedicated team including surgical oncologists, medical oncologists, and specialised intensive care nurses. They should follow international protocols and offer state-of-the-art operating theatres equipped with the specific perfusion machines needed for the procedure. Moreover, our team of oncologists has a proven track record in managing complex abdominal cancers.
Summary
Hyperthermic Intraperitoneal Chemotherapy represents a significant leap forward in the treatment of abdominal cancers. It combines two important steps in one procedure. First, surgeons remove visible tumours through cytoreductive surgery. Then, heated chemotherapy is delivered directly into the abdominal cavity to target any remaining microscopic cancer cells.
The warmth of the chemotherapy helps the medicine penetrate tissues more effectively and increases its cancer-killing ability. Because the drug is placed inside the abdomen rather than given only through the bloodstream, it works directly at the site where cancer cells are most likely to remain.
HIPEC cancer treatment is a major surgery, and recovery can take time. However, for carefully selected patients, it may improve disease control and, in some cases, extend survival. For many individuals facing peritoneal cancers, Aster Hospitals offers a focused and scientifically supported treatment approach that gives them the best possible chance to overcome this challenging disease.
Frequently Asked Questions
What is HIPEC and how does it work?
HIPEC (Hyperthermic Intraperitoneal Chemotherapy) is a treatment given during surgery for abdominal cancers. After tumour removal, heated chemotherapy is circulated inside the abdomen to destroy remaining microscopic cancer cells.
Is HIPEC better than traditional chemo?
Traditional chemo travels through the whole body, while hyperthermic intraperitoneal chemotherapy or HIPEC is delivered directly to the abdomen during surgery. HIPEC uses higher doses of heat-activated drugs with fewer systemic side effects.
Which cancers can be treated with HIPEC?
HIPEC can be rarely curative, particularly for advanced abdominal cancers that have spread to the peritoneal lining. Moreover, those with appendiceal cancer or mesothelioma experience a significant extension of life expectancy and control of symptoms when combined with other treatments.
How long does the HIPEC procedure take?
The entire process is lengthy. The cytoreductive surgery can take many hours, followed by 60 to 90 minutes of the heated chemo bath. Patients can expect to be in the theatre for 8 to 14 hours.
How long does recovery take after HIPEC treatment?
Recovery is longer than standard surgery. Most patients need to stay in the hospital for about 10 to 14 days. Moreover, it may take 3 to 6 months for full recovery, and within this period, patients regain full strength, and they may return to their daily activities.
Who is the best candidate for HIPEC?
Ideal candidates have tumours confined to the lining of the abdomen, no distant metastases (like liver or lung mets), and are physically fit enough to withstand a major operation. An experienced oncologist can assess your suitability through scans and tests.
Who is the best oncologist in Dubai for HIPEC cancer treatment?
The multidisciplinary oncology team at Aster Hospitals is highly regarded for advanced HIPEC cancer treatment in Dubai. Their expertise in cytoreductive surgery and HIPEC, supported by advanced surgical infrastructure and comprehensive care, makes them an effective cancer treatment facility.