HIPEC: Hyperthermic Intraperitoneal Chemotherapy

No. Cytoreduction is the surgery that removes all visible tumor implants. HIPEC is the heated chemotherapy perfusion delivered afterwards inside the abdomen, aimed at the residual microscopic disease. They are two distinct phases of the same operation.

No. It depends on the origin of the tumor, the available protocol, previous treatments and the board's assessment. The PRODIGE 7 trial showed that, in disease of colorectal origin with short-course oxaliplatin, adding HIPEC did not improve overall survival. What matters is achieving a complete cytoreduction.

No. HIPEC acts only inside the abdominal cavity. Intravenous chemotherapy reaches the whole body, including any disease that may exist outside the peritoneum. They are complementary and are usually combined within the same strategy, with systemic chemotherapy before or after surgery depending on the case.

Hyperthermia, between 41 and 43 °C, enhances the cytotoxic effect of the drugs and improves their penetration into tissue. That penetration is estimated at a few millimeters, and this limited depth explains why HIPEC only makes sense when surgery has left minimal or no residual tumor.

Mainly mitomycin C, oxaliplatin and cisplatin, depending on the origin of the tumor. Mitomycin C is preferred in international recommendations for colorectal and appendiceal origin. Cisplatin is used more in ovarian origin and in peritoneal mesothelioma, where it is combined with doxorubicin, as it is in gastric cancer.

Usually between 6 and 12 hours, in a single surgical procedure under general anesthesia. The HIPEC perfusion takes 30 to 90 minutes of that time, depending on the protocol and the drug used. The rest is the cytoreduction, whose duration depends on the extent of the disease.

The hospital stay is roughly 7 to 14 days, with an initial period in intensive care depending on the extent of the surgery. After discharge, several weeks are usually needed to regain strength, appetite and usual activity. Enhanced recovery protocols shorten both periods.

Those of any major abdominal surgery, plus the toxicity of the perfused drug. The main ones are infection, bleeding, respiratory complications, thrombosis, kidney problems, delayed bowel transit and healing problems at the digestive anastomoses. The center's case volume is associated with fewer severe complications.

It is the scale that measures the extent of the disease. It divides the abdomen into 13 regions and scores the size of the implants in each one from 0 to 3, up to 39 points. No figure automatically indicates or rules out surgery: the location of the implants matters as much as the total score.

When a complete cytoreduction is not possible, the goal becomes controlling the disease. In selected cases PIPAC may be considered: pressurized aerosol chemotherapy given by laparoscopy, repeatable over several sessions and especially useful for controlling ascites.