Cytoreduction with HIPEC is a powerful and potentially life-saving treatment for peritoneal mesothelioma patients. This multimodal procedure includes abdominal surgery to remove affected parts of the peritoneum and the application of heated chemotherapy in the abdominal cavity to kill remaining cancer cells.
What Is Cytoreductive Surgery With HIPEC?
Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment that combines surgery and chemotherapy to treat peritoneal mesothelioma and other gastrointestinal cancers.
It is the most effective curative treatment currently available for peritoneal mesothelioma.
Cytoreductive surgery with HIPEC requires 2 major steps:
- Surgery: Surgeons remove the lining of the abdomen (peritoneum) from the abdominal cavity along with all visible mesothelioma tumors. They may also need to remove organs or parts of organs affected by the cancer.
- Chemotherapy: Once cytoreduction is complete, heated chemotherapy drugs are circulated through the abdominal cavity to kill any cancer cells left behind by the surgery.
Patients who undergo HIPEC have a median life expectancy of 34-92 months, compared to the 12-27 month life expectancy of those treated with traditional chemotherapy alone. That’s a difference of up to five years.
Medical Overview of HIPEC Surgery
Cytoreductive surgery with HIPEC is a straightforward but lengthy two-step process best carried out by experienced mesothelioma specialists. If you are considering the procedure, speak to your treatment team about any potential risks as well as benefits.
Part 1: Cytoreduction
Cytoreduction, also called debulking, attempts to reduce the number of cancerous cells in the body by surgically removing all visible evidence of mesothelioma tumors.
What to expect during a cytoreductive surgery:
- You will be given an IV and anesthetized, and remain under anesthesia for the rest of the procedure.
- The surgeon makes an incision in your abdomen, stretching from the bottom of the sternum down to the pubic bone.
- Any parts of the abdominal lining (peritoneum) affected by mesothelioma tumors are removed in a process called a peritonectomy.
- The surgeon removes all other visible tumors in the abdominal cavity. They may also need to remove certain organs or parts of organs.
- After all mesothelioma tumors have been removed through debulking, surgeons prepare the peritoneal cavity to receive HIPEC.
Part 2: Heated Chemotherapy
HIPEC involves the application of heated cancer drugs (hyperthermia) directly into the abdominal cavity. This helps kill any remaining cells left behind by the surgery and slows mesothelioma regrowth.
What to expect during HIPEC:
- Temperature probes (used to track the temperature of the heated chemotherapy solution during the procedure) are inserted, and in-flow/out-flow catheters are installed in the abdomen.
- The abdomen is temporarily closed using sutures, and doctors use the catheters to rinse the abdomen with a saline solution.
- Chemotherapy drugs, heated to about 107 degrees Fahrenheit, are added to the saline solution using the in-flow catheter. The surgeon massages the abdomen to ensure that the chemotherapy fully covers the affected area.
- The chemotherapy remains in the abdominal cavity for about 90 minutes before being drained using the out-flow catheter. Saline solution is used to rinse the cavity one more time.
- The patient’s abdomen is reopened so the probes and catheters can be removed, then closed, ending the procedure.
How Long Does HIPEC Surgery Take?
Cytoreductive surgery can take anywhere between 8-14 hours. The farther the cancer has spread through the abdominal cavity, the longer the surgery takes. The second part of the procedure, the application of HIPEC, takes around 90 minutes on average.