Cytoreductive Surgery (CRS) With Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Better Outcomes for Patients With Peritoneal Cancer

CRS HIPEC offers a number of benefits for peritoneal cancer patients whose disease hasn’t responded to standard chemotherapy and/or radiation therapy. By extending overall survival and providing a cure in some cases, CRS HIPEC provides hope to many patients with peritoneal cancer.

University Hospitals Seidman Cancer Center has been doing CRS HIPEC since 2011, and our outcomes are on par with other national studies and established Peritoneal Disease Centers. Qualified as a high-volume location for CRS HIPEC treatment, UH Seidman Cancer Center is one of a few select cancer centers in the country to offer this groundbreaking, life-extending therapy. In addition, our surgical oncology team is actively engaged in research to improve the treatment and outcomes of CRS HIPEC patients.

What Is CRS HIPEC Used For?

CRS HIPEC is used to treat cancers that spread from any organ within the abdomen to the surrounding abdominal lining (called the peritoneum). Cancers may include:

• Colorectal cancer
• Signet ring cell cancer
• Appendix cancer, including pseudomyxoma peritonei (PMP)
• Gastric cancer
• Ovarian cancer

Benefits of CRS HIPEC Treatment

Studies indicate that CRS followed by HIPEC can significantly increase survival for patients with peritoneal cancers. For some patients, CRS HIPEC offers a long-term cure. As a result, CRS HIPEC allows doctors and their patients to manage peritoneal cancer less as a terminal condition and more as a chronic disease like high blood pressure or diabetes.

How CRS HIPEC Works

CRS HIPEC is two-step procedure that combines surgery with chemotherapy. In the first step – called cytoreductive surgery (CRS) – the surgical team removes the cancerous tumor or tumors from the abdomen. In the second step, a high dose of heated chemotherapy is applied directly into the abdominal cavity to kill any remaining cancer cells. CRS in combination with HIPEC is also called HIPEC surgery.

1. CRS
   • You will sleep through the entire CRS HIPEC procedure under general anesthesia.
   • At the beginning of the procedure, a surgeon may use a minimally invasive scope (laparoscope) to examine the inside of your abdomen.
   • The surgical team then works systematically throughout the abdomen to remove all visible cancer.
2. Chemoperfusion – HIPEC
   • Once all visible tumor tissue has been cleared out, the surgical team circulates a concentrated, heated chemotherapy solution, often mitomycin C, throughout the abdomen to destroy any remaining cancer cells.
   • The chemotherapy solution is heated to 108 degrees Fahrenheit (42 degrees Celsius). Heating enhances the cancer-killing effects of the chemotherapy. This step of the procedure is sometimes called a “hot chemo bath.”
   • The HIPEC solution is circulated throughput the abdomen for approximately 90 minutes.
   • Afterward, the abdomen is washed with a sterile solution.

The entire CRS HIPEC procedure usually takes from six to eight hours.

Preparing for HIPEC Surgery

Prior to HIPEC surgery, you will meet with your surgeon and support team. Your providers will discuss with you the risks and benefits of the procedure and details regarding your hospitalization. Your surgical team also discusses your care with a multidisciplinary team of doctors and other providers.

After the Procedure

After HIPEC surgery, you will be admitted to the hospital. Patients typically go home 5 to 10 days following their surgery. While in the hospital, you will be cared for by a team that includes your surgeon, nurses, students, assistants, therapists and social workers.

Your recovery will continue at home. Similar to other major surgeries, patients usually require several weeks before they feel normal again. During that time, your surgical team stays in touch with you to monitor your recovery and symptoms, coordinate your treatment planning and address any other needs that may arise.