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Hyperthermic Intraperative Peritoneal Chemotherapy (HIPEC)

Wednesday, March 7, 2018
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HIPEC: Hyperthermic Intraperitoneal Chemotherapy

 

HIPEC is a treatment modality for patients with peritoneal carcinomatosis. Patients who develop peritoneal carcinomatosis include those patients with appendiceal tumors, certain colon cancers, ovarian cancers as well as mesothelioma. There are some pediatric sarcomas as well which are commonly affected by peritoneal carcinomatosis. Historically these patients will be treated with surgery, chemotherapy, but the natural history unfortunately is actually rather poor for these patients. Cytoreduction hyperthermic intraperitoneal chemotherapy was first popularized in the late 80s, early 90s by Dr. Sugarbaker and has really revolutionized how we treat these patients and we’re able to offer this locally in Memphis as well.

How do I know if I’m a candidate for HIPEC?

Often times, patients with peritoneal carcinomatosis, especially those from colon cancer origin, or from ovarian cancer origin or with high grade appendiceal tumors will have been treated up front with systematic chemotherapy depending on the type of chemotherapy and recover from that prior to proceeding with cytoreduction hyperthermic intraperitoneal chemotherapy.

Are there other considerations before having HIPEC surgery?

One of the important things we want to ensure before we operate and take patients to the operating room for cytoreduction and HIPEC is that we ruled out other disease processes. We want to make sure that there’s no other spread outside of the abdominal cavity and make sure that there are no other missed areas of disease that we wouldn’t be able to treat.

How is the HIPEC surgical procedure performed?

Cytoreduction hyperthermic intraperitoneal chemotherapy surgery is a surgical procedure where we take the patient to the operating room under general anesthesia; we open the abdomen, and evaluate the entire abdominal cavity. We determine the extent of the disease by calculating something called the peritoneal cancer index score, the PCI score. The PCI score is a subjective measure that we determine in the operating room of how much disease is present. The abdomen is divided into nine regions and the small intestine is divided into four quadrants. Each region or quadrant is given a score anywhere between 0 and 3 depending on the size of the disease in that respected area. Each quadrant is then calculated and a final score is given. Scores can range anywhere from 0 to 39. Typically a score or 20 or less is deemed a good candidate for cytoreduction hyperthermic intraperitoneal chemotherapy. Once we calculate PCI score, we then try to visibly remove all disease in the abdominal cavity. We systematically inspect the abdomen from the top all the way from the diaphragm all the way down to the pelvis removing disease wherever it may be located. Once all the disease has been removed, then we place catheters within the abdominal cavity while the patient is asleep. We fill the abdomen with saline and then we connect that to a heated profusion pump. We then circulate the saline and once it reaches a target temperature of 42 degrees Celsius, we then administer the chemotherapy. The chemotherapy is heated because this allows us to have additional tumor killing effects of chemotherapy and that’s the reason we refer to it as hyperthermic intraperitoneal chemotherapy. Other common acronyms include “Shake & Bake”, “Hot Chemo”, as well as the “Sugarbaker Technique”. And then once the chemo profusion is complete, we then finish the operation. Patients are taken to the recovery room and then to the ICU where they begin the recovery process.

What is the recovery time and treatment plan after HIPEC?
                Once patients undergo cytoreduction hyperthermic intraperitoneal chemotherapy, they typically stay in the ICU overnight and then are transferred to the surgical ward. The hospital stay typically last from 7 to 10 days depending on the length of the procedure and how patients recover. Once patients are discharged from the hospital, we see them at 2 weeks and then one month after surgery and then we follow patients for 6 months thereafter, typically with physical examination, tumor markers, as well as CT scan imaging. Some patients do need additional therapy after cytoreduction hyperthermic intraperitoneal chemotherapy depending on the pathology treatment.

What are your hopes for those that need this innovative procedure?

The reason I’ve chosen to dedicate my career to treating patients with peritoneal carcinomatosis is that historically many of these patients would have been referred only to palliative care or supportive measures with limited treatment options. I think we’ve been able to help numerous patients; hopefully we’ll continue to help many others to live a long-lasting full life.

The video below is West Cancer Center’s Dr. Jeremiah Deneve, DO, FACS, surgical oncologist, discussing the HIPEC procedure in detail, along with its advantages for cancer patients.