What is HIPEC?
HIPEC stands for Hyperthermic IntraPEritoneal Chemotherapy, an established treatment for patients with certain types of cancer that either originate in or metastasize (spread) to the abdomen. HIPEC is performed in combination with tumor-removal surgery, also called cytoreduction or debulking surgery.
After the tumors are removed, the abdominal cavity is bathed with a high dose of heated chemotherapy that kills any remaining cancerous cells. HIPEC is a procedure done immediately after complete cytoreduction, which involves circulating a high dose of heated (about 107 F) chemotherapy into the abdominal cavity. The combination of aggressive cytoreduction and intraperitoneal chemotherapy with heat has been shown in numerous clinical trials to be effective at preventing recurrences in certain patients with carcinomatosis or extensive intra-abdominal malignancies.
What Types of Cancer Can Be Treated with HIPEC?
Certain types of cancer respond favorably to a combination of tumor-removal surgery (also called cytoreductive or debulking surgery) and HIPEC. These cancers either originate in the abdomen or the peritoneum (the thin membrane that covers the abdominal and pelvic organs), or they have spread there from other areas of the body. These tumors include:
appendiceal (appendix) cancer
Who Is a Good Candidate for HIPEC?
Patients are carefully selected for cytoreduction and HIPEC based on the type and location of the tumor and whether there is a high likelihood that the surgery and HIPEC treatment will result in a positive outcome for the patient. Because the surgery may take many hours and requires general anesthesia, the patient must be physically able to withstand a lengthy operation.
What Happens During HIPEC?
HIPEC is an adjunct (added) treatment that is combined with tumor-removal surgery (also called cytoreductive or debulking surgery) to treat advanced abdominal and gynecologic malignancies.
For most patients with these cancers, surgery is the primary treatment. But even when all traces of the tumor are removed, microscopic cancer cells can be dislodged or can linger behind in the abdominal cavity. When surgery is combined with HIPEC, there is a greater chance that these microscopic cancer cells will be destroyed and cancer will not recur.
Dr. Harrison first performs cytoreduction (removal of all the tumor). Immediately after, while the patient is still under anesthesia, a high dose of warmed chemotherapy (about 107 degrees Fahrenheit) is circulated throughout the abdomen, bathing it for 90 minutes. The concept behind HIPEC is that the heated chemotherapy kills any microscopic cancer cells that remain in the abdomen. Once completed, Dr. Harrison then drains away the chemotherapy liquid and closes the surgical incision.
Depending on the type of surgery required, the procedure may take four to 12 hours. After the entire procedure, the patient is moved to the recovery area to wake up. The patient will stay in the ICU or step down unit for 12 to 36 hours and may have a tube in the nose for drainage and/or tubing from the bladder and other areas to either remove fluid or provide nutrition. Patient-controlled analgesia (PCA) will be given to manage pain as needed.
After a period of recovery, the patient will be taken to a bed on the surgical unit. Generally, the patient will recuperate here for five to 10 days, depending on the extent of surgery. The patient will be transitioned from a liquid diet to a solid one, although a special tube for nutritional support may be needed. By the second day after surgery, the patient will be able to sit in a chair, and then with the help of a physical therapist will be encouraged to walk. The patient will be able to go home once he/she is able to eat, walk, and move the bowels (some patients will have a colostomy). Within four to six weeks, most patients can usually resume their normal activities.
What Are the Benefits of HIPEC?
A chemotherapy "bath" can access hard-to-reach areas in the abdomen or peritoneum (membrane over the abdominal and pelvic organs), where microscopic cancer cells can hide.
The heat used during HIPEC enhances the penetration of chemotherapy into tissues and increases its toxicity to cancer cells.
HIPEC goes only to the areas it needs to treat. It does not travel throughout the entire body, like systemic chemotherapy. Because HIPEC is a regional treatment, patients do not experience the nausea, vomiting, and other side effects that are typical of systemic chemotherapy.
Because the chemotherapy is delivered immediately after tumor removal surgery with HIPEC instead of waiting until the patient heals from surgery, the tumor cells are eliminated before they have a chance to get into scar tissue that results from wound healing.
HIPEC is safe in select patients and has few potential risks. However, because it extends the time of the operation an additional 90 minutes, patients in frail condition or those with health problems may not be candidates for HIPEC.
What Should I Bring for My Evaluation with Dr. Harrison?
You should bring the most recent originals or copies of the following to your first visit:
X-rays, CT scans, MRIs, and PET scans (either films or a CD, as well as reports)
original pathology slides
current insurance card
any referral forms required by your health insurance carrier
Dr. Harrisons office is located in The Valley Hospitals Daniel & Gloria Blumenthal Cancer Center at the Robert and Audrey Luckow Pavilion in Paramus. For more information or to make an appointment, call 201-634-5547. We are happy to assist in arranging local accommodations if required.
Medical Photo Gallery
CT scan of a patient with mucinous appendiceal cancer. Arrows show the presence of tumor.
CT scan of a patient with mucinous collection surround the spleen, as shown by the arrow.
Intraoperative view of carcinomatosis.
CT scan of a patient with ovarian cancer. Arrows show the presence of tumor.
About Dr. Harrison
Lawrence E. Harrison, M.D.
Lawrence E. Harrison, M.D., is Director of Surgical Oncology at The Valley Hospital Daniel and Gloria Blumenthal Cancer Center. His practice focuses on the treatment of peritoneal-based malignancies, such as colon, appendix, and ovarian tumors. Dr Harrison has performed over 100 HIPEC cases and also has performed both basic and clinical research in this area. He also specializes in the treatment of patients with gastrointestinal cancers, with a concentration on patients with hepatobiliary, pancreatic, and gastro-esophageal malignancies.
Dr. Harrison received his medical degree from the Temple University School of Medicine. He completed a surgical residency at the University of Massachusetts Medical Center. He subsequently spent four years at Memorial Sloan-Kettering Cancer Center, where he completed a research fellowship and a surgical oncology fellowship. Prior to joining Valley, Dr. Harrison was Chief of Surgical Oncology at UMDNJ-New Jersey Medical School for 13 years. He has been performing HIPEC for more than 11 years.
HIPEC Research Performed by Dr. Harrison
Reichman TW, Cracchiolo B, Sama J, Bryan M, Harrison, J, Pliner L, Harrison LE Cytoreductive Surgery and Intraoperative Hyperthermic Chemoperfusion for Advanced Ovarian Carcinoma. J Surg Onc 90:51-58, 2005.
Wang C, Chen F, Kim E, Harrison LE. Thermal sensitization through ROS modulation: A strategy to improve the efficacy of hyperthermic intraperitoneal chemoperfusion. Surgery 142(3) 384-92, 2007
Chen F, Wang C, Harrison LE. Hyperthermia combined with t-BOOH induces autophagic cell death and retardation of S phase in HT-29 colon cancer cells. Cell Biol Int 32(7) 715-23, 2008
Chen F, Rezavi R, Wang C, Harrison LE. Proteasome inhibition potentiates the cytotoxic effects of hyperthermia in HT-29 colon cancer cells through inhibition of heat shock protein 27. Oncology, 73:98-103, 2008
Harrison LE, Bryan M, Pliner L, Saunders. Phase I trial of pegylated liposomal doxorubicin with hyperthermic intraperitoneal chemotherapy in patients undergoing cytoreduction for advanced intra-abdominal malignancy. Ann Surg Oncol 15(5) 1407-13, 2008
Senthil M, Harrison LE. Simultaneous Bicavitary Hyperthermic Chemoperfusion in the Management of Pseudomyxoma Peritonei with Synchronous Pleural Extension Arch Surg. 2009 Oct;144(10):970-2.
Razavi R, Harrison LE Thermal sensitization using induced oxidative stress decreases tumor growth in an in vivo model of hyperthermic intraperitoneal perfusion Ann Surg Oncol 17(1) 304-11, 2010
Harrison LE, Tiesi G, Razavi R, Wang C. A phase I trial of thermal sensitization using induced oxidative stress in the context of HIPEC
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