HIPEC & PIPAC Surgery: New-age treatment for abdominal cancers

Q1: What are peritoneal surface cancers? 

Peritoneal surface cancers refer to malignancies that spread to the peritoneum, the inner lining of the abdominal cavity protecting internal organs. Common types include ovarian cancer, colorectal cancer, gastric cancer, appendix cancer , pseudomyxoma peritonei and mesothelioma. Involvement of peritoneum in any cancer is referred to as advanced stage cancer and it can cause significant complications as it affects the abdominal organs and can lead to ascites (fluid accumulation) and intestinal obstruction.

Q2: What is HIPEC Surgery? 

HIPEC, or Hyperthermic Intraperitoneal Chemotherapy is a surgical procedure where chemotherapy is heated and then directly infused into the abdominal cavity after the cancer along with involved peritoneum has been surgically removed which is known as Cytoreductive Surgery. The heated chemotherapy solution is circulated in the abdominal cavity for a specified period (usually 60 to 90 minutes). The combination of heat and direct application helps improve drug absorption while reducing systemic side effects.

Q3: What are the benefits of HIPEC?

The benefits of HIPEC include improved local control of cancer, reduced recurrence rates, and enhanced survival outcomes for patients with peritoneal surface cancers. It is particularly beneficial for cases where traditional systemic chemotherapy would be less effective due to tumor location or extent.

Q4: What are the risks associated with HIPEC? 

HIPEC is a major surgical procedure and most of the patients are hospitalised for around 12-14 days. During the stay, the recovery process is monitored closely to detect any complications. The common complications associated with HIPEC are respiratory, renal, chemotherapy-related, incomplete healing of bowel anastomosis and infections. To reduce these complications, it is advisable to consider HIPEC only at tertiary care hospitals which includes surgeons trained in performing HIPEC, trained teams in anaesthesia, ICU critical care, and medical oncology to manage chemotherapy-related complications, expert radiology and oncopathology teams for correct diagnosis (stage, grade and type of cancer), intervention radiology to help manage post-operative complications, and a rehabilitation team to ensure smooth and early recovery.

Q5: What is PIPAC?  

PIPAC, or Pressurized Intraperitoneal Aerosol Chemotherapy, is another innovative technique for delivering chemotherapy directly to the peritoneal cavity, but in aerosol form. This method uses a laparoscopic procedure to administer chemotherapy under pressure, allowing for better distribution to cancerous tissues.

Q6: How does PIPAC differ from HIPEC? 

The primary difference between PIPAC and HIPEC lies in the method of delivery. HIPEC involves heated liquid chemotherapy delivered during open surgery, while PIPAC uses a minimally invasive approach to aerosolize chemotherapy under pressure. PIPAC can also be administered multiple times, whereas HIPEC can only be given at the time of cytoreductive surgery.

Q7: Who are the candidates for HIPEC and PIPAC?  

Candidates for HIPEC typically include patients with peritoneal surface cancers like  ovarian cancer, colorectal cancer, gastric cancer, appendix cancer , pseudomyxoma peritonei and mesothelioma who have undergone surgical tumor resection (complete cytoreduction surgery) and those whose cancer has not spread beyond the peritoneum. PIPAC is often considered for patients who may not be candidates for cytoreductive surgery due to advanced disease or for those seeking further treatment options after surgery.

Q8: What are the outcomes for patients receiving HIPEC or PIPAC?  

Research has shown that both HIPEC and PIPAC can lead to improved survival rates or better quality of life for patients with peritoneal surface cancers. However, individual outcomes depend on factors like cancer type, stage, and the patient's overall health, necessitating tailored treatment plans.

Q9: How do I find out if HIPEC or PIPAC is right for me?  

The best approach is to consult with an expert surgical oncologist specializing in peritoneal surface cancers. They will evaluate your condition, discuss treatment options, and determine the most appropriate course of action based on your unique situation.