Department of Peritoneal Surface Oncology - Advanced Treatment for Abdominal Cancers

INTRODUCTION – Pioneering Peritoneal Surface Oncology in North India 

Fortis Hospital Mohali is proud to introduce the region's first dedicated Department of Peritoneal Surface Oncology – a highly specialized branch of surgical oncology focused on treating cancers that spread to the peritoneal surface (the lining of the abdominal cavity).

Peritoneal metastases, once considered untreatable, can now be managed with advanced techniques like HIPEC (Hyperthermic Intraperitoneal Chemotherapy) and PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy). Our internationally trained surgical oncologists bring cutting-edge treatments to patients who previously had limited options.

Fortis Hospital Mohali is regarded among the most advanced treatment centers for abdominal cancers in Mohali, providing specialized care through HIPEC and PIPAC without the need to travel outside the region.

WHAT IS PERITONEAL SURFACE ONCOLOGY?

Peritoneal surface oncology is an established subspecialty of surgical oncology that focuses on cancers affecting the peritoneum – the membrane lining your abdominal cavity and covering your organs. When cancer spreads to this lining (peritoneal metastases or carcinomatosis), it creates a challenging clinical situation that requires specialized expertise.

Cancers We Treat:

• Ovarian Cancer with peritoneal spread
• Colorectal Cancer with peritoneal metastases
• Gastric (Stomach) Cancer with peritoneal carcinomatosis
• Appendiceal Cancer (Pseudomyxoma Peritonei)
• Peritoneal Mesothelioma
• Primary Peritoneal Cancers
• Recurrent Abdominal Cancers with peritoneal involvement

HIPEC: HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY

Overview

HIPEC (Hyperthermic Intraperitoneal Chemotherapy) is a powerful, two-step treatment for advanced abdominal cancers that have spread to the peritoneal surface. This procedure combines aggressive surgery with heated chemotherapy to improve outcomes in carefully selected patients.

How HIPEC Works

Step 1: Cytoreductive Surgery (CRS)
Removal of all visible tumors from the abdominal cavity, including:
• Tumor deposits from the peritoneal lining
• Involved organ segments (intestine, spleen, gallbladder, etc.)
• Tumor from diaphragm or abdominal wall
Goal: Complete removal of all visible disease

Step 2: Heated Intraperitoneal Chemotherapy
Immediately after CRS:
• Heated chemotherapy (41-43°C / 106-109°F) is circulated for 60–90 minutes
• Internal surfaces are bathed to kill microscopic cancer cells
• Heat is drained and incisions are closed

Why HIPEC Is Effective

1. Direct Drug Delivery
   • High-dose chemotherapy reaches tumor surfaces directly
   • 20–1000x concentration vs. IV chemotherapy
   • Low systemic toxicity
2. Heat Makes Chemotherapy More Potent
   • Cancer cells become 2–4x more sensitive
   • Heat damages membranes
   • Better drug penetration
3. Proven Survival Benefits in Select Cancers
   • Appendiceal Cancer
   • Ovarian Cancer
   • Colorectal Peritoneal Metastases
   • Gastric Cancer (selected cases)
   • Peritoneal Mesothelioma

HIPEC Candidate Profile

HIPEC benefits patients with:
• Limited peritoneal disease
• Good performance status
• No major disease outside the abdomen
• Responsive cancer types (appendiceal, ovarian, colorectal, mesothelioma)

HIPEC Patient Expectations

Surgery Duration: 6–12 hours
Hospital stay - 7 to 10 days 

Recovery 

Return to light activity = 2-3 weeks 

Full recovery = 6 to 8 weeks 

Side Effects: Temporary ileus, fluid accumulation, infection risk, chemotherapy-related effects

PIPAC: PRESSURIZED INTRAPERITONEAL AEROSOL CHEMOTHERAPY

Overview

PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy) is a minimally invasive technique for patients with peritoneal metastases where standard treatment is limited. It offers disease control with faster recovery.

How PIPAC Works

Performed laparoscopically:

1. Small incisions (keyhole access)
2. Chemotherapy converted into fine aerosol
3. Aerosol sprayed under controlled pressure
4. Pressure enables deeper tumor penetration
5. Aerosol evacuated after 30 minutes
6. Patients discharged same or next day

Why PIPAC Helps

1. Better Tumor Penetration
   • Reaches hidden tumors 3–4x more effectively
   • Penetrates avascular tumor tissue
   • Covers surfaces conventional methods miss
2. Lower Physical Burden
   • Low systemic toxicity
   • Quick recovery
   • No major incisions
   • Suitable for frail patients
3. Repeatable Treatment
   • Every 4–8 weeks
   • Allows reassessment
   • Improves quality of life
4. Clinical Evidence Shows
   • Tumor shrinkage in ovarian, colorectal, gastric cancers
   • Stabilization after failed systemic therapy
   • Improved quality of life
   • Possible bridge to HIPEC in selected patients

PIPAC Is Useful For:

• Unresectable peritoneal metastases
• Chemotherapy-resistant disease
• Frail patients unfit for major surgery
• Malignant ascites control
• Downstaging before curative surgery
• Ovarian, gastric, colorectal, appendiceal disease

PIPAC Patient Expectations

Procedure Duration: 60–90 minutes
Hospital Stay: Same day to 1 night
Recovery: 3–7 days
Course: 3–6 sessions based on response
Side Effects: Mild discomfort, nausea, low-grade fever

HIPEC vs. PIPAC: WHICH IS RIGHT FOR YOU?

Aspect                   HIPEC                                                     PIPAC
Best For                Completely resectable disease            Unresectable/extensive disease
Intent                     Curative in select cases                        Palliation/control or bridge
Invasiveness         Major open surgery                              Minimally invasive
Hospital Stay        10–21 days                                             Same day–1 night
Recovery               3–6 months                                           3–7 days
Repeatability        One-time                                               Multiple sessions
Patient Fitness     Requires good status                          Suitable for frail patients
Treatment decisions are individualized by a multidisciplinary tumor board.

WHY CHOOSE FORTIS MOHALI FOR PERITONEAL SURFACE ONCOLOGY

First & Only Dedicated Department in Tricity

Key Strengths

• Regional pioneers in peritoneal surface oncology
• Surgeons trained internationally in HIPEC & PIPAC
• Complete cytoreductive surgery capability
• Certified HIPEC perfusion systems
• Certified PIPAC delivery systems
• Robotic surgery support

Multidisciplinary Structure

Includes:
• Surgical oncology
• Medical oncology
• Radiology with peritoneal imaging expertise
• Pathology with peritoneal specialization
• Dedicated ICU & oncology nursing

Infrastructure

• Advanced ICU for post-HIPEC care
• Modern laparoscopic platforms for PIPAC
• CT, MRI, PET-CT for staging
• On-site pathology & tumor markers

With a dedicated multidisciplinary setup, patients seeking the most advanced treatment for abdominal cancers in Chandigarh frequently present to our Peritoneal Surface Oncology department for evaluation and care.

PATIENT JOURNEY (Diagnosis to Recovery)

Step 1: Initial Consultation
• Review of history and imaging
• Physical examination
• Discussion of goals and options

Step 2: Multidisciplinary Evaluation
• Tumor board review
• Advanced imaging (CT/MRI) if needed
• Tumor markers
• Diagnostic laparoscopy if indicated

Step 3: Treatment Planning
• HIPEC vs. PIPAC vs. Combination
• Pre-operative optimization
• Nutrition support
• Patient & family counseling

Step 4: Treatment
• HIPEC: Major surgery + ICU care
• PIPAC: Minimally invasive day procedure

Step 5: Recovery & Follow-Up
• Monitoring
• Imaging & markers
• Further treatment if required
• Survivorship support

FREQUENTLY ASKED QUESTIONS

Is HIPEC/PIPAC experimental?

No. HIPEC has been performed worldwide for over 30 years and is considered standard of care for specific cancers like pseudomyxoma peritonei. PIPAC is newer (developed in 2011) but is now practiced in leading cancer centers globally with growing evidence of benefit.

Will insurance cover these treatments?

Most insurance plans cover HIPEC for approved indications (appendiceal cancer, selected ovarian/colorectal cases). PIPAC coverage varies; our team assists with insurance approvals and documentation.

How do I know if I'm a candidate?

Schedule a consultation with our peritoneal surface oncology team. We'll review your case comprehensively and provide honest assessment of whether these treatments could benefit you.

Can HIPEC or PIPAC cure my cancer?

HIPEC can be curative for certain cancers, particularly appendiceal cancer (pseudomyxoma peritonei) and some ovarian cancers. PIPAC is primarily for disease control and palliation, though it may enable curative surgery in select cases. Our team will discuss realistic goals for your specific situation.

What if I'm not a candidate for HIPEC or PIPAC?

We offer comprehensive cancer care including systemic chemotherapy, targeted therapy, immunotherapy, palliative surgery, and supportive care. Our goal is to find the best treatment plan for you.

How experienced is your team?

Our surgical oncologists have completed specialized training in peritoneal surface oncology at international centers of excellence and have performed numerous HIPEC and PIPAC procedures.