1. Surgical exploration
Complete evaluation of the abdominal cavity to determine the extent of disease and calculate the peritoneal carcinomatosis index (PCI).
Reviewed by Dr. Juan José Torrent · Updated: July 29, 2026
Specialized Procedure
HIPEC: Hyperthermic Intraperitoneal Chemotherapy
Combined treatment of cytoreductive surgery and heated intra-abdominal chemotherapy for the treatment of peritoneal carcinomatosis with curative intent.
CONTACT SPECIALISTWhat is HIPEC?
HIPEC (Hyperthermic Intraperitoneal Chemotherapy) is a procedure that combines cytoreductive surgery with the direct application of heated chemotherapy inside the abdominal cavity. It is used to treat tumors that have spread to the peritoneum (peritoneal carcinomatosis).
The goal is to remove all visible tumor implants through surgery and then apply heated chemotherapy to destroy residual microscopic cancer cells. Hyperthermia (heat) enhances the effect of chemotherapeutic drugs.
How is the HIPEC procedure performed?
The HIPEC procedure is performed in the operating room under general anesthesia and consists of several phases:
2. Complete cytoreduction
Removal of all visible tumor implants, including peritonectomies and resection of affected organs if necessary.
3. HIPEC application
Perfusion of the abdominal cavity with chemotherapy heated to 41-43°C for 60-90 minutes, ensuring contact with all peritoneal surfaces.
4. Reconstruction
Performing intestinal anastomoses and closing the abdominal cavity after draining the chemotherapy solution.
When is HIPEC indicated?
HIPEC is especially indicated for the following tumors with peritoneal involvement:
Pseudomyxoma peritonei
Mucinous appendiceal tumors with peritoneal spread. This is the indication with the best results, achieving long-term survival rates above 80%.
Peritoneal mesothelioma
Primary tumor of the peritoneum where HIPEC has demonstrated significant survival benefit when complete cytoreduction is achieved.
Ovarian cancer
HIPEC has shown benefit in advanced ovarian cancer, especially in the context of interval surgery after neoadjuvant chemotherapy.
Colorectal carcinomatosis
In selected cases of colorectal carcinomatosis with low tumor burden and favorable biology.
Benefits of HIPEC treatment
HIPEC offers unique advantages in the treatment of peritoneal carcinomatosis:
Intensive local treatment
Chemotherapy is administered directly where the disease is located, reaching concentrations up to 20 times higher than systemic chemotherapy.
Lower systemic toxicity
When applied locally, systemic side effects are fewer than with conventional intravenous chemotherapy.
Synergistic effect of heat
Hyperthermia increases the penetration and effectiveness of chemotherapeutic drugs in tumor tissue.
Curative potential
In selected indications, HIPEC offers the possibility of cure in patients who previously only had palliative options.
Our experience in HIPEC
At Quenet-Torrent Institute we have one of the largest national and international experiences in cytoreductive surgery and HIPEC. Our team has performed more than 500 HIPEC procedures with oncological results published in high-impact scientific journals.
We work in a multidisciplinary environment that includes medical oncologists, radiologists, specialized anesthesiologists, and nursing staff with specific training in this complex procedure.
Pathologies treated with HIPEC
The HIPEC procedure is used in the treatment of various pathologies with peritoneal involvement.
Peritoneal carcinomatosis
Comprehensive treatment of peritoneal tumor spread from various origins.
More informationGynecological tumors
Especially indicated in advanced ovarian cancer with carcinomatosis.
More informationColorectal tumors
In selected cases of colorectal carcinomatosis.
More information
EXPLANATORY VIDEO
Cytoreductive surgery plus HIPEC, step by step
Dr. Juan José Torrent Correa explains how HIPEC fits into a multidisciplinary strategy combining systemic treatment, cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Video in Spanish.
- What the surgery aims for and what the perfusion adds
- Why complete cytoreduction determines the outcome
- The weight of patient selection and team experience
HIPEC drugs and protocols
There is no single HIPEC protocol. The drug, dose, temperature and perfusion time vary according to tumour origin, prior treatment and the centre's protocol.
Mitomycin C
The preferred agent in Peritoneal Surface Oncology Group International recommendations for peritoneal disease of colorectal and appendiceal origin, in longer perfusions.
Oxaliplatin
Used in short-course regimens. This is the protocol assessed in the PRODIGE 7 trial, which showed no overall survival benefit in colorectal disease.
Cisplatin
Commonly used in carcinomatosis of ovarian origin and in peritoneal mesothelioma, frequently in combination with other agents.
Temperature and duration
The perfusion is maintained between 41 and 43 °C for 30 to 90 minutes depending on protocol, with continuous thermal control and homogeneous distribution throughout the cavity.
What the scientific evidence says about HIPEC
The PRODIGE 7 trial, led by Dr. François Quénet and published in The Lancet Oncology, compared cytoreductive surgery alone with cytoreductive surgery plus short-course oxaliplatin HIPEC in peritoneal metastases of colorectal origin. With that protocol, HIPEC did not improve overall survival and was associated with more late postoperative complications.
This result is worth explaining properly, because it is often misread. Both arms of the trial exceeded 40 months of median survival, far beyond what systemic treatment alone would achieve. What sustains that result is complete cytoreduction. HIPEC is an adjunct whose indication depends on the case, not a universal requirement nor the element that defines prognosis.
An international analysis published in BJS Open in 2024, covering more than 2,000 patients, observed differing outcomes across HIPEC regimens without being able to establish the superiority of any, given its retrospective design. This is why we indicate HIPEC individually rather than automatically, and always after multidisciplinary board assessment.
Recovery after HIPEC and possible complications
The operation usually lasts between 6 and 12 hours in a single surgical session. Depending on its magnitude, the first hours may be spent in intensive care, and hospital stay is broadly 7 to 14 days.
After discharge, several weeks are usually needed to regain strength, appetite and usual activity. As with any major abdominal surgery, it carries risks that should be understood before deciding: infection, bleeding, respiratory complications, thrombosis, impaired renal function, delayed return of bowel transit, healing problems at digestive anastomoses, and toxicity from the drug used in the perfusion.
Case volume and team experience are consistently associated with lower rates of severe complications.
Frequently asked questions about HIPEC
Answers to the most common questions about the procedure, its indication and recovery.
Are cytoreduction and HIPEC the same treatment?
No. Cytoreduction is the surgery that removes all visible tumour implants. HIPEC is the heated chemotherapy perfusion delivered afterwards inside the abdomen, targeting residual microscopic disease. They are two distinct stages of the same operation.
Is HIPEC always given after cytoreduction?
No. It depends on tumour origin, available protocol, prior treatment and board assessment. The PRODIGE 7 trial showed that in colorectal disease with short-course oxaliplatin, adding HIPEC did not improve overall survival. What matters most is achieving complete cytoreduction.
Does HIPEC replace intravenous chemotherapy?
No. HIPEC acts locally within the abdominal cavity and systemic chemotherapy reaches the whole body. They are usually combined within a single therapeutic strategy.
Why is the chemotherapy heated?
Hyperthermia, between 41 and 43 °C, enhances the cytotoxic effect of the drugs and improves their penetration into tissue, estimated at a few millimetres. That limited depth explains why HIPEC only makes sense when surgery has left minimal or no residual tumour.
Which drugs are used in HIPEC?
Mainly mitomycin C, oxaliplatin and cisplatin, according to tumour origin. Mitomycin C is preferred in Peritoneal Surface Oncology Group International recommendations for colorectal and appendiceal disease, while cisplatin is more frequently used in ovarian origin and peritoneal mesothelioma.
How long does the operation take?
Usually between 6 and 12 hours, in a single operation under general anaesthesia. The HIPEC perfusion accounts for 30 to 90 minutes of that time, depending on protocol.
How long are the hospital stay and recovery?
Hospital stay is broadly 7 to 14 days, with a possible initial period in intensive care. After discharge, several weeks are usually needed to regain strength, appetite and usual activity.
What complications can HIPEC have?
Those of any major abdominal surgery: infection, bleeding, respiratory complications, thrombosis, renal impairment, delayed return of bowel transit and healing problems at digestive anastomoses, together with toxicity from the perfused drug. A centre's case volume is associated with lower rates of severe complications.
What is the Peritoneal Cancer Index (PCI)?
It is the scale that measures the extent of disease. It divides the abdomen into 13 regions and scores implant size in each 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.
What if HIPEC cannot be performed?
When complete cytoreduction is not possible, the goal shifts to disease control. In selected cases PIPAC may be considered, a pressurised aerosol chemotherapy delivered laparoscopically, repeatable over several sessions and particularly useful in controlling ascites.
Where do we perform HIPEC?
We operate in two private hospitals of reference in Spain. The same medical team treats you in Madrid and Barcelona, with the same surgical and oncological standards.
Madrid
Memorial Publio Cordón Hospital
Private hospital in Pozuelo de Alarcón with a multidisciplinary team specialised in digestive surgical oncology and cutting-edge surgical technology.
View hospital
Barcelona
Centro Médico Teknon
Internationally recognised private hospital in Barcelona where the team carries out its high-complexity surgical oncology activity.
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Real cases
Patients who survived cancer thanks to Quenet
Real testimonies from patients treated by our team in high-complexity surgical oncology.
Debra's case
66-year-old English woman with advanced ovarian cancer and peritoneal metastases. Treated with cytoreduction + HIPEC, she is now disease-free.
Read the full caseRosario (Charo)'s case
73-year-old patient with advanced cancer treated with chemotherapy and high-complexity surgical oncology. Excellent survival and quality of life.
Read the full caseFelipe's case
A mistaken diagnosis of terminal colon cancer that a second opinion revealed to be pseudomyxoma peritonei, treatable with cytoreductive surgery and HIPEC.
Read the full caseSantiago's case
Diagnosed with widespread peritoneal carcinomatosis and considered inoperable. After complete cytoreduction with HIPEC, today his is a story of hope and survival.
Read the full case
Verified reviews
See on Google
★★★★★
What our patients say
L
4 weeks ago
★★★★★
Wonderful surgical team, among the best out there. Dr. Torrent (expert in peritoneal carcinomatosis) is an exceptional surgeon and an even better person. His coordinator is super kind, fast and efficient. The human treatment is great and the results are too. This is of vital importance for cancer patients.
K
5 months ago
★★★★★
In the public healthcare system they gave my father a maximum of one year to live. They only offered him chemo and no hope, said it was impossible, that nothing could be done. He had several tumors inside the peritoneal sac with metastases. A year and a half later he is clean, completely cured. His latest PET scan came back clean. We are very happy. Thanks to Dr. Torrent and his team. THANK YOU.
M
A year ago
★★★★★
Excellent professionals, especially Dr. Torrent, attentive at all times to the patient (my wife), operated for peritoneal pseudomyxoma. They helped us with all our needs since we came from outside Barcelona. Thank you Elisabeth. We are very grateful to Quenet Torrent Institute, thank you for everything.
P
2 years ago
★★★★★
I am a 63-year-old patient. They detected adrenal gland cancer and told me there was nothing to be done. I sought a second opinion and they told me about the Quenet Torrent team, specialists in complex operations. Dr. Torrent, from the first moment, told me they could operate. They operated and removed a large tumor mass. I spent a week in the ICU and a month on the ward. Every day he came morning and evening, no matter Saturday or Sunday. Never throw in the towel. I am happy to have found these professionals who gave me my life back. Thank you.
I
3 years ago
★★★★★
Many thanks for your attention. Dr. Torrent always attentive, involved and decisive. The reception staff very pleasant and always offering the best option. 100% RECOMMENDED. THANK YOU.
M
5 years ago
★★★★★
Dr. Torrent helped me make the best decision at a difficult moment. I think he is a great professional and a person capable of accompanying you and putting himself in another's shoes. Thank you for everything.
F
6 years ago
★★★★★
I have peritoneal carcinomatosis. Sending my diagnosis to every center, practically all agreed on palliative chemo with little survival time since I had very aggressive cell types. Until we reached Dr. Quenet, Dr. Torrent and their team. I can only confirm what their CV announces: they are far ahead of the rest. They saved my life, at surgery the harmful cells everyone diagnosed (and used to refuse to operate) were not there. This intervention has become the best investment of my life.
M
6 years ago
★★★★★
The best decision of my life was finding this excellent team of surgeons who saved my husband's life. At a prestigious international clinic in Madrid he was given up for lost with advanced peritoneal carcinomatosis from appendiceal cancer, and thanks to them, the best professionals in this field, he was operated on very successfully. A perfect recovery with no complications, because they were on top of his progress at all times. They have a great quality: from the start they were very honest and close. I can only be deeply grateful; we went to buy time and thanks to them my husband got his life back.
E
7 years ago
★★★★★
Dr. Torrent is a brilliant surgeon and a very easy-going and polite doctor. When talking with him you can easily grasp his qualities as a professional and human being: perseverance, innate curiosity and passion for learning, humility, honesty and empathy. Having surgery is always an intense experience, anxieties arise and one feels very vulnerable. All of that being said, as his ex-patient I can assure that throughout the process his care and professionalism were absolutely outstanding. I felt safe, supported by him, knowing I was in good hands. I will be forever grateful. Moltes gràcies Dr. Torrent!
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Side Effects of HIPEC: What to Expect and How to Manage Them
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HIPEC in the Treatment of Gastric Peritoneal Carcinomatosis
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Cytoreductive Surgery as the Cornerstone of Peritoneal Carcinomatosis Treatment
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