Hyperthermic Intraperitoneal Chemotherapy – H.I.PE.C

Up until recently, patients witth diffuse intraperitoneal carcinomatosis, had no treatment option left, other than systemic chemotherapy. Intraperitoneal carcinomatosis is the diffuse involvement of the surface of the abdominal organs with a thick layer of cancer cells. Unfortunately, chemotherapy in this setting is not usually successful because cancer cells have already become resistant to these agents. Most often, carcinomatosis is associated with ascites, which is abdominal fluid collection, and can be especially uncomfortable for the patients.

In such patients, HIPEC may be the only realistic therapeutic alternative available. During HIPEC, there is a continuous flow of chemotherapy-rich fluid at 42 degrees Celsius inside the abdominal cavity for 90 minutes. Before HIPEC is initiated, all grossly visible and ppalpable disease should be resected; this is called «debulking» and should be as thorough and complete as possible. At that stage, specially designed tubes are positioned inside the abdominal cavity for inflow and outflow. These tubes are appropriately connected to a device that can provide continuuous flow of fluid at a constant set temperature. The circulating hot, chemotherapy-rich fluid fills the abdomen, so as every inch of its inner surface and the surface of all intra-abdominal organs are bathed in it. The direct contact of this kind of fluid to the cancer cells that remain scattered in the abdomen, provides for their «distinction». This process lasts for 90 minutes, the tubes are then removed and the operation is completed.

Tumors in which HIPEC has shown tthe best results are cancer of the ovaries, and pseudomyxoma peritonei (a rare mucosy, «jello-type», superficially expanding cancer). It is essential to understand that HIPEC can only be performed under very specific circumstances:

1. Prior complete and thorough resection of all macroscopic disease (debulking),

2. Absence of hematogenous metasttases to other organs,

3. Realistic expectations by the patient.