HIPEC

Hyperthermic Intraperitoneal Chemotherapy

In March 2022, Baptist MD Anderson Cancer Center implemented a new treatment modality, Hyperthermic Intraperitoneal Chemotherapy (HIPEC), that will be used for advanced abdominal cancers. The treatment involves delivering chemotherapy directly into the abdominal cavity. “Hyperthermic Intraperitoneal Chemotherapy is critically important because it allows us to provide advanced treatment for patients with a tumor in the belly cavity, for which we previously had few options,” said Niraj Gusani, MD, FACS, chief of surgical oncology at Baptist MD Anderson.

HIPEC can be used to treat several abdominal cancers including colorectal cancer, appendiceal cancer, ovarian cancer, peritoneal mesothelioma and stomach cancer. These cancers can occasionally affect the lining of the abdomen, which limits complete resection by the surgeon. Providing HIPEC directly to the abdominal cavity can benefit patients with these conditions. “Appendiceal cancer, peritoneal mesothelioma and peritoneal carcinomatosis from colorectal cancer treated with HIPEC have all shown substantial improvement in outcomes compared to historic data, and it is a significant addition to the armamentarium of our state-of-the-art cancer center that offers the whole array of therapies for challenging cases,” said Konstantinos Chouliaras, MD, surgical oncologist at Baptist MD Anderson. HIPEC is usually coupled with cytoreductive surgery, which involves removing all visible tumors within the peritoneal cavity before administering the HIPEC treatment. “Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy represents a technique that offers new hope to appropriately selected patients with peritoneal spread of their cancer,” said Dr. Chouliaras. During the HIPEC treatment, the surgeon instills chemotherapy directly into the abdomen to treat the microscopic disease that could be lingering in the abdominal lining after cytoreductive surgery. The fluid is circulated with the help of a pump and gentle agitation of the abdominal cavity to ensure that it comes into contact with all the exposed surfaces that could harbor cancer. It is important to note that the fluid is heated to 42 degrees Celsius (108 degrees Fahrenheit), and the high temperature acts as a “second hit” helping kill cancer cells and increasing the penetration and efficacy of the chemotherapy. This chemotherapy perfusion, or “chemo bath” can last anywhere from 90 minutes to two hours and is designed to kill any remaining cancer cells. HIPEC is a major abdominal operation that can range from eight to 16 hours. Once the doctors locate the tumors, a variety of techniques are employed to remove them completely, sometimes removing different organs (such as the intestine, the gallbladder, the spleen or others) at the same time. One of the key components is the removal of the peritoneum (the thin wallpaper-like tissue that envelops the abdominal cavity) that contains cancer, a procedure called a peritonectomy. The recovery time for this procedure is between seven to 14 days in the hospital. Both Dr. Chouliaras and Dr. Gusani have experience in conducting cytoreductive surgery, removing tumors from the belly cavity, and performing HIPEC in their previous roles. They are looking forward to implementing this procedure for their patients at Baptist MD Anderson. The benefits of a HIPEC treatment include its ability to apply a high concentration of chemotherapy to the abdominal tumors without as much systemic absorption, therefore reducing side effects. “Hyperthermic intraperitoneal chemotherapy allows us the best chance to eradicate the tumor, and it may provide the best hope to those who have complex and advanced abdominal cancers,” said Dr. Gusani. “We are excited to implement this unique technique at Baptist MD Anderson and establish a referral center for Northeast Florida and beyond.”

Pictured left to right: La Treasia Allen, Dr. Chouliaras, Dr. Gusani and Emily Cramer, RN, outpatient oncology nurse.

Video

Learn more about HIPEC by watching a video featuring Dr. Chouliaras and Dr. Gusani.