Cytoreductive Surgery (CRS) With Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
Many patients with peritoneal cancer benefit greatly from cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Peritoneal cancer, also called peritoneal disease, refers to cancer that begins somewhere within the abdomen – for example, the colon or the stomach – and spreads (metastasizes) to the peritoneum. The peritoneum is a sheet of smooth tissue that lines the abdominal wall and covers most of the organs in the abdomen.
Backed by years of published studies at experienced medical centers, CRS HIPEC consists of the surgical removal of peritoneal cancer combined with a type of chemotherapy in which a heated solution containing an anti-cancer drug is delivered directly into the abdominal cavity following the surgery to destroy any leftover cancer cells. CRS HIPEC is usually done as part of a multidisciplinary treatment approach that may also include traditional intravenous chemotherapy.
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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.
Specific benefits of CRS HIPEC include:
- Higher drug concentration
Cancer drugs used in HIPEC are confined to the abdomen, which allows the doctor to safely deliver drug therapy at a significantly higher and more effective concentration than is possible with standard intravenous chemotherapy.
- Better contact with cancer cells
Unlike standard intravenous chemotherapy, HIPEC exposes abdominal tumors directly to anti-cancer drugs.
- Enhanced tissue penetration
The heated HIPEC solution causes tiny blood vessels in the abdomen to dilate, which allows the drug penetrate abdominal tissues more deeply that traditional chemotherapy to reach microscopic cancer cells.
- Better targeting of cancer cells
Heat improves the ability of the chemotherapy to destroy cancer cells.
- Fewer side effects
Because the delivery of HIPEC is restricted to the abdomen, only a very small amount of the anti-cancer drug can reach the rest of the body, which causes fewer side effects in comparison to traditional chemotherapy.
- Shorter hospital stay
Patients typically stay in the hospital for about seven days following CRS HIPEC.
- Ascites control
HIPEC is effective at controlling and reducing ascites (buildup of fluid in the abdomen) that can accompany cancers that have spread to or throughout the abdomen.
- Prevention of bowel obstruction
Advanced abdominal cancers can cause bowel obstructions that interrupt digestion and prevent patients from eating. When started early, HIPEC can prevent such obstructions.
- Improved quality of life
Research indicates that CRS HIPEC can help patients maintain or improve their quality of life by reducing pain and improving emotional well-being.
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.
- 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.
- 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.