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:

• Small incisions (keyhole access)
• Chemotherapy converted into fine aerosol
• Aerosol sprayed under controlled pressure
• Pressure enables deeper tumor penetration
• Aerosol evacuated after 30 minutes
• Patients discharged same or next day

Why PIPAC Helps

Better Tumor Penetration
• Reaches hidden tumors 3–4x more effectively
• Penetrates avascular tumor tissue
• Covers surfaces conventional methods miss

Lower Physical Burden
• Low systemic toxicity
• Quick recovery
• No major incisions
• Suitable for frail patients

Repeatable Treatment
• Every 4–8 weeks
• Allows reassessment
• Improves quality of life

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 respectable 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.