Side effects of HIPEC: what to expect and how to manage them

HIPEC: side effects and how they are controlled

HIPEC (Hyperthermic Intraperitoneal Chemotherapy) combined with cytoreductive surgery is a complex treatment that can cause side effects. Knowing about them helps you know what to expect during recovery.

At Quenet Torrent Institute we apply perioperative care protocols designed to reduce these effects and speed up recovery.

Immediate side effects (first 48-72h)

Hypothermia:

After heated chemotherapy (42-43°C) is given, the patient may have temporary hypothermia as the body cools. We manage this with thermal blankets and controlled warming in the ICU.

Haemodynamic changes:

Changes in blood pressure and heart rate during HIPEC. Continuous monitoring in the ICU with inotropic support if needed. They usually stabilise within 24-48h.

Fluid and electrolyte imbalances:

Heat and chemotherapy can cause imbalances in sodium, potassium and calcium. Frequent blood tests and immediate correction with intravenous fluids.

Gastrointestinal effects (first 7-10 days)

Prolonged paralytic ileus:

Temporary paralysis of the bowel caused by surgical handling and the effect of chemotherapy. It can last 4-7 days (vs 2-3 days in surgery without HIPEC).

• Management: Nasogastric tube if there is vomiting, temporary parenteral nutrition, gradual start of oral diet

• Prevention: ERAS protocol with early mobilisation and chewing gum

Nausea and vomiting:

Common in the first days after surgery because of the effect of chemotherapy

• Management: Potent antiemetics (ondansetron, metoclopramide, aprepitant)

• They usually improve after 48-72h

Diarrhoea:

It can appear weeks later because of chemotherapy toxicity in the intestinal lining

• Management: Binding diet, probiotics, loperamide, adequate hydration

Haematological effects (7-21 days)

Myelosuppression (fall in blood cells):

• Anaemia: May require transfusion of red cell concentrates. Supplementation with intravenous iron and erythropoietin

• Leucopenia: A fall in white blood cells increases the risk of infection. Monitoring, prophylactic antibiotics, colony-stimulating factors (G-CSF) if there is severe neutropenia

• Thrombocytopenia: Low platelet count. Caution with bleeding, transfusion if <20,000/mm³

These effects are usually mild to moderate and reversible within 2-4 weeks.

Renal effects

Nephrotoxicity:

Especially with cisplatin. It can cause a temporary rise in creatinine.

• Prevention: Generous perioperative hydration, magnesium sulphate infusion

• Monitoring: Daily check of kidney function, fluid adjustment

• Usually reversible. Permanent kidney failure: <2% of cases

Surgical complications

Anastomotic leaks (5-8%):

Breakdown of the bowel joins. HIPEC may slightly increase the risk compared with surgery alone.

• Symptoms: Fever, abdominal pain, leakage of contents through the drains

• Management: Antibiotics, parenteral nutrition, percutaneous drainage or reoperation if needed

Intra-abdominal infections (10-15%):

Abscesses or postoperative peritonitis

• Prevention: Perioperative prophylactic antibiotics, meticulous surgical technique

• Management: Broad-spectrum antibiotics, radiological percutaneous drainage

Postoperative bleeding (3-5%):

May require transfusion or reoperation

• Prevention: Meticulous surgical haemostasis, correction of coagulopathy

Medium- to long-term effects

Intestinal adhesions:

They can cause bowel obstruction months or years later (10-15% of patients)

• Management: Conservative at first (liquid diet, nasogastric tube). Surgery if there is no response

Peripheral neuropathy:

With oxaliplatin: tingling in the hands/feet, sensitivity to cold

• Usually mild and reversible within 3-6 months

• Treatment: B vitamins, gabapentin if symptomatic

Chronic fatigue:

It can persist for 3-6 months after surgery

• Management: Gradual exercise, optimal nutrition, adequate rest

Factors that influence side effects

Extent of surgery (PCI): Greater tumour extent means more aggressive surgery and more adverse effects

Type of chemotherapy: Mitomycin C: more myelosuppression. Cisplatin: more nephrotoxicity. Oxaliplatin: better tolerated

Duration of HIPEC: 60 vs 90 minutes can influence toxicity

Temperature: 41-42°C is generally better tolerated than 43°C

Age and comorbidities: Patients >70 or with previous conditions are at higher risk

Nutritional status: Malnutrition increases complications. The importance of prehabilitation.

Prevention and management

At Quenet Torrent Institute we reduce side effects through:

Rigorous patient selection: Only candidates with a high probability of complete cytoreduction and adequate functional status

Preoperative optimisation: Nutrition, cardiovascular status, anaemia

ERAS protocol: Multimodal analgesia, early start of feeding, early mobilisation

Intensive monitoring: ICU for 24-48h, strict haemodynamic and metabolic control

Experienced multidisciplinary team: Surgeons, anaesthetists, intensivists, specialised nursing

Comparison with systemic chemotherapy

Although HIPEC has significant side effects because it is a complex procedure, it is generally better tolerated than long courses of systemic chemotherapy:

• HIPEC: Effects concentrated in the perioperative period, recovery in weeks

• Systemic chemotherapy: Cumulative effects over months, chronic toxicity

• HIPEC: Minimal systemic exposure: less hair loss, less mucositis, less neuropathy

• Oncological advantage: HIPEC allows local concentrations 10-100x higher

When to contact the medical team

Contact us immediately if you have:

• Persistent fever >38.5°C

• Severe abdominal pain

• Uncontrollable vomiting

• No bowel movement for >7 days

• Signs of infection in the surgical wound

• Bleeding through the drains

• Shortness of breath or chest pain