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frequent asked questions

What is HIPEC?

HIPEC stands for Hyperthermia Intraperitoneal Chemotherapy. The procedure is a unique combination of heat and chemotherapy, primarily used to treat patients with cancers in the abdominal cavity. The procedure includes a physical removal of all visible tumors, followed by a 90 minute internal bath of heated chemotherapeutic solution.

Why is HIPEC preferred over traditional chemotherapy treatments?

HIPEC offers high loco-regional drug concentrations and low systemic toxicity, which gives us fewer side-effects and greater efficacy than with traditional intravenous chemotherapy.

What types of cancer is HIPEC used to treat?

HIPEC is used to treat colon, appendix, abdominal, and gastrointestinal cancers, as well as PseudomyxomaPeritonei. The use of HIPEC has been extended recently to other types of cancers, such as lung and ovarian.

Is HIPEC experimental?

HIPEC is not considered experimental. Many health insurance companies will cover the procedure.

What are the success rates of the HIPEC procedure?

In numerous studies, HIPEC has been shown to greatly increase survival times. In a 2008 French study, peritoneal carcinamatosis patients who received only traditional chemotherapy had a median survival time of 24 months, compared with 63 months for patients treated with cytoreductive surgery and HIPEC. More study results can be found by searching the U.S. National Library of Health, at http://www.ncbi.nlm.nih.gov/, for the query HIPEC.

How popular is the HIPEC procedure?

While the number of procedures performed annually is growing rapidly, there are still few institutions that are equiped to perform HIPEC. The procedure requires expertise and training by surgeons and staff, and the hospital must also support many associated concerns such as pre-operative evaluation, intra-operative management and decision making, and post-operative recovery.

If I have to undergo CRS and HIPEC, does that mean that I have an incurable cancer?

If you have to undergo CRS and HIPEC, then it means that you have a stage IV cancer in most cases and that it is in such a distribution that it is possible to remove it completely and give you a chance of cure. However, without CRS and HIPEC, the disease will invariably be fatal and there will be no chance of cure.

What is the rationale behind CRS and HIPEC?

Peritoneal surface malignancies have a tendency to spread along the entire peritoneal surface (membrane lining the inner surface of the abdomen and enveloping several important organs within the abdomen) by the phenomenon of redistribution. Chemotherapy given intra-venously (the traditional form of chemotherapy) will not reach the peritoneal cavity in adequate concentrations due to the inherent blood-peritoneal barrier. Moreover, previous surgical adhesions and disease load may further hamper the effectiveness of IV chemotherapy.

To tackle these drawbacks of traditional treatment strategy, the CRS+HIPEC protocol has been developed. It involves as its first step, a surgery that removes all of the affected peritoneum and organs and this is the corner stone in a successful outcome. Once all visible disease as been removed by this surgery, the microscopic disease is then treated by giving a bath of chemotherapy that is circulated directly within the abdomen at high concentrations, high temperature (hyperthermia) and high flow rate using a special machine and a closed-circuit mechanism. This ensures that all the residual microscopic disease is also destroyed and the patient is rendered disease free from the abdomen so that the intra-venous chemotherapy can then have optimum effect.

What does the outcome depend upon?

The outcome depends on the type of disease (for example a patient with pseudomyxoma due to a borderline appendiceal tumor has a better outcome than a patient with carcinomatosis arising from a cancer of the rectum). It also depends on the extent of the disease, the pattern of spread, the sensitivity to chemotherapy and whether there is disease at other sites (for example, in the liver or the lungs). Your doctor will give you this information after reviewing all the reports and scans.

What are the preparations that need to be done prior to the surgery?

A) A thorough workup to assess the extent of the disease needs to be done and will include a CT scan and perhaps even a PET-CT scan. In selected cases, the doctor may advice a Staging Laparoscopy to assess the extent of the disease. This is a small procedure done under general anesthesia where a scope is introduced through a small opening in the abdomen to assess the extent of the disease.

B) You will be admitted 2-3 days prior to the surgery for evaluation and preparation for the surgery. Evaluation may include certain blood tests, a cardiac evaluation and an evaluation by the Anesthetist. If a recent good quality CT scan is not available, this may also need to be done on admission.

C) You will have to be on a low-fiber diet for a period of 1 week prior to surgery, and on liquid diet for 2 days prior to surgery. You can take a protein supplement during this period to maintain the protein intake.

D) You will be given a medication to clear your bowels a day before the surgery and will be kept fasting for 12 hours and on IV fluids for a variable period prior to the morning of surgery.

What is the usual post-operative course like?

In general, if the surgery is successfully completed, you will be in the Intensive care unit for a variable period of 8-12 days. This may also involve ventillatory support for some time. This ICU stay is because your fluid and nutritional intake and other parameters need close monitoring and timely intervention. CRS and HIPEC is generally associated with a slightly longer hospital stay compared to standard major abdominal surgeries as the patient tends to take a little longer than other surgeries to return back to normal diet and activity. During this period, the patient may require parenteral nutrition (nutrition given through the veins) and other supplements.

What are the complications that can happen after this procedure?

I: The complications depend entirely on the extent of the disease and the magnitude of the surgery (the extent of the resections performed). Majority of these complications can be treated by non-operative means. Occassionally, an interventional procedure may have to be performed and rarely a second surgery may be needed for complications.

A proficient team of medical experts, led by Dr. Sanket Mehta, Oncosurgeon, perform with the help of a combination of cytoreductive surgery and heated chemotherapy bath called HIPEC (hyperthermic intraperitoneal chemotherapy). This advanced technique for the treatment of colorectal cancer was used for the first time, on the premises of International Oncology Services Pvt Ltd at Hiranandani Hospital, Powai. The procedure is expected to relieve patients suffering from advanced stage of abdominal cancers like pseudomyxomas (cancers arising from the appendix), Mesothiliomas and primary peritoneal cancers. These are critical conditions where traditional treatment methods have not yielded good results.

Pankaj Jaiswal, the patient treated with HIPEC was earlier a cancer victim, whose disease had already spread to other areas of the abdominal cavity. Before visiting Dr. Mehta, the family was already counselled that the only treatment available was palliative chemotherapy, which would decrease the and control the disease for a short period but long-term survival was not possible. The patient was in a very good general condition and was quite motivated to get the treatment done.

Dr. Mehta started with an aggressive type of chemotherapy involving three types of that gave a good response, which is an encouraging sign in these types of patients. After careful evaluation, he was taken up for a surgery where all the diseased area was treated and then administered a heated chemotherapy bath directly into the abdomen, which is called as HIPEC using a special machine that delivers this chemotherapy at high concentration, high flow rate and a high temperature.

The combination of this aggressive surgery and HIPEC in fact could offer Pankaj Jaiswal a potential chance of long-term survival, according toDr Mehta.