Is HIPEC surgery for abdominal cancer right for me?

August 01, 2022 | by George I. Salti, M.D.

Every patient who has cancer in the abdomen should ask about HIPEC, or hyperthermic intraperitoneal chemotherapy, an advanced procedure that combines cancer surgery and chemotherapy. The result: a powerful cancer treatment that is more effective than either option alone.

Here, I’ll review what type of patients are candidates for HIPEC and the outcomes I’ve seen.

About half of the patients I treat with HIPEC have either colorectal cancer or appendix cancer. We also use HIPEC to treat other cancers, such as:

  • Certain types of ovarian cancer
  • Certain sarcomas, which affect muscles, tendons, nerves, blood vessels and other connective tissues
  • Gastric (stomach) cancer
  • Mesothelioma, which forms in the thin abdominal tissue called the mesothelium
  • Peritoneal carcinomatosis, which affects the abdominal cavity lining called the peritoneum

Not every patient with one of these cancer types can safely or effectively be treated with HIPEC.

Who is a candidate for HIPEC surgery?

First, we look at the patient’s medical fitness, or their physical ability to withstand the procedure. HIPEC is a difficult surgery that can last 7-10 hours. Not every patient is able to handle such a lengthy surgery. We work with each patient’s medical oncologist or other specialists to make sure they meet the minimum level of medical fitness.

Next, we have to make sure we can remove the primary tumor and any tumors that have spread throughout the abdomen. There are four main ways cancer can spread through the belly:

  • Bloodstream
  • Local growth, or spreading to areas through direct contact
  • Lymph nodes
  • Transabdominal spread, or spreading throughout the abdomen

HIPEC is most useful in treating transabdominal spread. Some abdominal cancers attach on the surface of an organ, rather than on the inside. When these cancer cells rupture, it can spread the cancer almost like a spray, with cancer cells attaching in many other places throughout the abdomen. Cancer that spreads this way can be a huge challenge to remove with surgery alone.

We use imaging tests like computed tomography (CT) scans and magnetic resonance imaging (MRI) scans to help us see where tumors are located in a patient’s abdomen and whether we can remove them surgically. Our goal is to leave no visible tumors behind. Any cancerous cells that we have to leave must be smaller than 2.5 millimeters in diameter. This helps to ensure the chemotherapy we introduce during the HIPEC procedure can penetrate and kill the cancer cells.

Lastly, we have to make sure HIPEC is likely to help the patient. For example, if the patient’s cancer has spread outside the abdominal cavity, HIPEC is no longer a good option. Because HIPEC works by circulating chemotherapy medication inside the abdominal cavity, it isn’t a good option to treat cancer that isn’t confined there. Likewise, HIPEC isn’t an effective option for certain abdominal cancers, such as pancreatic cancer that has spread outside the pancreas.

To discuss whether HIPEC is a good fit for you, call 630-646-6020, or schedule a meeting with me through our online request form.

HIPEC helps more patients live longer

At Edward-Elmhurst Health, we have a good team that is experienced in performing HIPEC surgery. I’ve been performing HIPEC surgery since 2001 — longer than any other Chicago-area surgeon.

Our experience contributes to our patients’ recoveries and good outcomes after surgery. For patients with sarcomas whom we have treated with HIPEC surgery, we’ve improved survival compared with patients who haven’t had the HIPEC procedure.

Related reading: A history of HIPEC cancer surgery in Chicago

In the past, doctors thought that older patients wouldn’t do as well with surgeries like HIPEC. But that assumption is changing. Like our international colleagues, we’ve shown high rates of positive surgical outcomes among elderly patients who have undergone HIPEC. Our patients between the ages of 65-80 have similarly low complication rates and high survival rates compared to patients in their early 60s.

Discuss HIPEC with your doctor

Every patient who has cancer in the abdomen should have a discussion about HIPEC. Not everyone will be a good candidate, but the surgery should at least be discussed. Ideally, the discussion would take place as soon as possible after a diagnosis. That’s better than waiting until late in the disease process, after HIPEC may no longer be an option.

Related reading: From Guatemala to Chicago: Daniel’s HIPEC journey

I’ve had many such discussions with my patients over the years. I saw one patient after he was diagnosed with a form of cancer called peritoneal sarcomatosis, which happens when sarcomas develop throughout the lining of the abdomen. Other institutions had declined to even consult with him, telling him, “There’s nothing we can do.”

He didn’t accept that, so he came to see me. I performed surgery to remove his tumor and followed up with the HIPEC treatment to eliminate any remaining traces of cancerous tissue. As of May 2022, he has been cancer-free for 15 years.

In the meantime, my patient has moved to Florida, although he has kept coming to see me for regular follow-up visits until the COVID-19 pandemic. I told him he doesn’t really need follow-up appointments anymore, based on his good health. But he told me he wants to keep coming anyway. When I asked him why, he said, “Every time I come, I keep the hope going.”

HIPEC gave this patient hope after others had turned him away. And it can do so for many others who are good candidates for the procedure.

About Dr. Salti

George I. Salti, M.D., is chief of surgical oncology and professor of surgery at Edward-Elmhurst Health. He specializes in surgical treatment of cancers affecting the abdomen, appendix, gastrointestinal tract and many others. Learn more about Dr. Salti and how to request an appointment.

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