HIPEC: Hyperthermic Intraperitoneal Chemotherapy

Hyperthermic intraperitoneal chemotherapy, or HIPEC, allows physicians to circulate very high concentrations of chemotherapy throughout the abdominal cavity with minimal to no exposure to the rest of the body.

 

Hyperthermic (or Heated) Intraperitoneal Chemotherapy (HIPEC) is a state-of-the-art procedure for treating cancers that have spread to the abdomen. In the past, patients with advanced cancers have had few medical alternatives. Today, HIPEC offers a new treatment option – even for people who have been told they have no options.

Froedtert Hospital in Milwaukee, Wis., is a leading cancer center for HIPEC surgery. Our physicians are active in HIPEC research and developing many HIPEC cancer treatment advances. Our Radiology Department is a leader in using advanced imaging technologies in the early detection of cancer, including cancers that can be treated with HIPEC.

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HIPEC Video FAQ

Callisia Clarke, MD, and T. Clark Gamblin, MD, MS, MBA, surgical oncologists, explain heated intraperitoneal chemotherapy (HIPEC) in the video FAQ below.

What are the potential benefits of HIPEC surgery?

Cytoreduction and HIPEC surgery offer a lot of benefit to patients who traditionally have not been able to get significant disease control from standard chemotherapy or radiation. Peritoneal malignancies are very challenging cancers, and studies have shown that chemotherapy alone is insufficient in treating patients and their symptoms. But, with cytoreduction and HIPEC surgery, we've been able to offer hope to many patients with this disease and ultimately give them longer overall survival and, in some cases, a cure.

What should I expect after HIPEC surgery?

Recovery after HIPEC varies on an individual basis. In general, our patients will typically leave the hospital in about seven to 10 days after their surgery. After initial surgery, we follow our patients very closely to monitor for complications in the immediate post-operative period as well as for tumor recurrence over time. Initially, we see our patients back every few months or so to do a physical exam. We also get repeat imaging studies to see if there are any new tumors that have developed since our last examination. As you get further and further away from your initial diagnosis without any evidence of disease, we're able to spread out those follow-up visits to more of an annual basis. Long-term quality of life varies depending on the extent of the surgery that was required to remove all of the tumor. In general, in about three to six months after surgery, patients will start feeling as if they're back to their baseline. Here, we have additional resources including physical therapists and dietitians who are dedicated to our HIPEC program that will help patients get back to their baseline faster.

How will the HIPEC team work with my personal physician?

When patients come to our center, sometimes, they’re concerned; they’re coming to an academic medical center, but this isn’t their home. They have a whole team of other physicians out in the community that have taken care of them all their lives. And they worry a little bit about how their team will be integrated with our team. And I would tell you, that’s done in a very personal way – in a very relationship-based way, where phone calls are made to referring doctors and letters are sent and images sent. We really want to allow patients to get most of their care close to home, realizing that coming to an academic medical center for the operation or some form of treatment may be necessary, but in no way are we trying to say we’re the only team to take care of that now. We’re really expanding the team onto our campus here in Milwaukee.

What are the outcomes for patients receiving HIPEC treatment for appendix and other advanced abdominal cancers?

Advanced GI cancer requires a lot of very complex operations. We're very proud of the fact that we've done literally hundreds of patients' operations here in Milwaukee. And we've seen a lot of fabulous results. We've seen patients 17 years out from HIPEC. We've seen patients who come in and say, “three years after my HIPEC, I decided to start my family and now I have a three-year-old with me.” In other words, they turn a corner from worrying about their cancer to getting on with living. And, I just can't tell you how rewarding that is.

Why is it important to choose an experienced HIPEC team for my surgery?

The biggest thing that a patient needs to take into consideration when undergoing HIPEC is the experience of the team that is providing their care. Studies have shown that your incidence of complication decreases significantly when you have your surgery at centers that are more experienced. We are proud to have taken care of hundreds of patients with peritoneal surface malignancies. Because we are a regional high volume center, our complication rates are much lower than national averages.

What types of experts make up the HIPEC team?

When patients come to visit us, they meet a team. Sometimes that’s three or four people, but what they represent, I think, is a team of 40 or 50 individuals that are thinking about their cancer. So, in a multidisciplinary way at a tumor conference, their images are presented, their pathology is discussed; we really lay out a consensus plan for how we’re going to care for these patients. So, I think that the people they meet, while incredibly important to the team, are really just representative of the much, much larger team that’s committed to this cancer.

What is the HIPEC team’s experience in treating patients who have complex abdominal cancers?

Clearly, as we offer this to the Midwest and the U.S., we think about being one of the highest volume centers. In other words, we see these patients, and we see these problems very frequently. They’re not new challenges for us; they’re challenges we welcome, and they’re challenges we understand how to take care of. Some of the operations we offer can carry a lot of potential complications. Some of those complications are unavoidable. But we have to offer a perfect operation, and then, anticipate any challenges that we might see down the road, so that we know if there are complications, they’re not new complications to our team, and they’re ones that we’re well equipped to manage.

Overview Benefits & Outcomes Who is a Candidate? What to Expect Doctors & Staff

HIPEC Procedure Uses Cytoreductive Surgery and Chemotherapy

In the HIPEC procedure, physicians deliver a high dose of heated chemotherapy directly into the abdomen. This innovative treatment strategy controls cancer while causing fewer side effects than conventional chemotherapy. 

“Intraperitoneal” means within the peritoneum, which is a membrane that lines the abdominal cavity. There are two parts to the HIPEC procedure: 

30 Pound Tumor News Item image

A Delavan woman was shocked to learn she had 30 pounds of tumors growing in her stomach from a rare type of appendix cancer. Her cancer team performed a HIPEC procedure to the abdomen. Now, six months later, the patient is cancer free and spreading the word about the outstanding care she received. Watch her story >>

  1. Cytoreductive surgery
    • At the start of the HIPEC procedure, a surgeon uses a minimally invasive scope called a laparoscope to inspect the inside of a patient’s abdomen.
    • If existing cancer tissue can be removed completely, a surgical incision is created.
    • The surgeon then works systematically throughout the abdomen to remove all visible tumors.
    • Tumor tissue can be removed using several methods, including ultrasonic ablation, thermal ablation (electroevaporative surgery, microwave) and cryoablation (or freezing). 
  2. Chemoperfusion
    • After all visible cancer tissue has been removed, the surgical team circulates a concentrated chemotherapy solution throughout the abdomen. The purpose is to expose microscopic cancer cells to the cancer-killing drug.
    • The chemotherapy solution is heated to approximately 102 degrees Fahrenheit, which increases the anti-cancer effect. This part of the procedure was sometimes referred to as a "hot chemotherapy," “hot chemo bath” or "chemo wash."
    • The surgical team circulates the solution for approximately 90 minutes, delivering high-dose chemotherapy to cells that coat the lining of the abdomen.
    • Afterward, the abdomen is washed with a sterile solution. 

The entire HIPEC procedure takes from six to eight hours. 

HIPEC Resources