When a surgeon recommends HIPEC, it can feel overwhelming. The name sounds complex, and the treatment involves major surgery. Knowing what the preparation involves can help you feel more in control.

HIPEC stands for hyperthermic intraperitoneal chemotherapy. It is generally combined with cytoreductive surgery, which removes visible tumour from the abdominal cavity. Heated chemotherapy is then circulated inside the abdomen for a set period.

What Is HIPEC?

In cytoreductive surgery with HIPEC, the surgeon first removes all visible cancer deposits in the abdomen. Then warmed chemotherapy solution is delivered directly into the abdominal cavity, aiming to treat microscopic cancer cells that remain. It is considered for selected patients with certain cancers that have spread within the abdominal lining, such as some ovarian, appendiceal, colorectal, and stomach cancers, and peritoneal mesothelioma. Whether it suits you is a decision for your multidisciplinary team.

Pre-Treatment Evaluation

Imaging

CT, MRI, or PET-CT scans assess how widely the disease has spread, and help the team judge whether complete tumour removal is achievable. Sometimes a diagnostic laparoscopy is done.

Blood Tests

Tests check blood counts, kidney and liver function, clotting, nutrition markers, and tumour markers.

Heart and Lung Assessment

ECG, echocardiography, and lung function tests, along with an anaesthetist's review, assess fitness for a long operation.

Pathology Review

Biopsy slides are reviewed to confirm cancer type, which influences the chemotherapy drugs chosen.

Tumour Board Discussion

A team of surgeons, oncologists, radiologists, and anaesthetists usually reviews your case before deciding on treatment.

Nutrition Before HIPEC

Good nutrition improves recovery and reduces complications.

• Aim for adequate protein, using sources such as dal, eggs, dairy, fish, and lean meat
• Eat small, frequent meals if appetite is low
• Stay well hydrated
• Your team may recommend oral nutritional supplements or other nutrition support
• Do not start herbal supplements without checking with your doctor

A dietitian can assess your nutritional status and set personalised targets.

Fitness and Prehabilitation

Being as fit as possible before surgery helps.

• Walk daily as your doctor advises
• Practise deep breathing exercises or use an incentive spirometer if given one
• Your team may suggest a physiotherapy-guided prehabilitation programme
• Stop smoking and avoid alcohol, ideally weeks before surgery
• Get adequate sleep and manage stress

Medicines and Preparation

Tell your team about all medicines, including blood thinners, diabetes medicines, and supplements. Some may need to be adjusted or stopped before surgery, but only on your doctor's instructions. Bowel preparation, fasting instructions, and antibiotic plans will be explained to you.

Emotional Preparation

A major cancer operation can cause worry. Ask questions, bring a family member to appointments, and consider speaking with a counsellor or a patient who has been through it.

What to Expect on the Day

• Surgery is performed under general anaesthesia and can take many hours
• The surgeon removes visible tumour deposits and sometimes parts of organs, depending on spread
• The heated chemotherapy is circulated inside the abdomen for a set period
• A stoma, which is an opening on the abdomen for waste, may be needed in some cases
• You will usually be monitored in intensive care or a high-dependency unit afterward

Recovery in Hospital

Hospital stay is typically longer than for routine abdominal surgery. The team will monitor pain, fluids, breathing, bowel function, and wound healing. Physiotherapy and early walking are encouraged. Nutrition is built up gradually.

Possible Risks

HIPEC combined with cytoreduction is a major procedure. Risks can include infection, bleeding, bowel leaks, blood count changes, and kidney effects. Your surgeon will explain the risks and benefits for your situation.

Questions to Ask Your Surgeon

• Why is HIPEC recommended for me?
• How likely is complete tumour removal?
• What are the risks and expected benefits?
• How long is the hospital stay and recovery?
• What follow-up treatment is planned?
• How often does your team perform this procedure?

Conclusion

Preparing for HIPEC involves thorough testing, nutritional care, fitness building, and emotional preparation. Working closely with your multidisciplinary team, and asking questions, helps you approach treatment with greater confidence.