Hyperthermic intraperitoneal chemotherapy (HIPEC)

Hyperthermic intraperitoneal chemotherapy (HIPEC) is a specialized cancer treatment used for certain types of advanced abdominal cancers. In HIPEC treatment, a high dose of chemotherapy, a drug to treat cancer, is heated and circulated through your abdominal cavity to remove cancer cells. Sometimes referred to as “hot chemotherapy”, it’s usually performed in combination with tumor removal surgery. This method allows the surgeon to first remove all visible tumors, called cytoreductive surgery, and then directly target chemotherapy to eliminate any remaining invisible cancer cells in a single treatment.

Surgery with HIPEC is not a cure for cancer, but it’s been shown to increase life expectancy and reduce the rate of cancer recurrence in some patients. Because HIPEC can be directly targeted at the sites of your tumors, it allows for a higher concentration of chemotherapy to be delivered into your abdomen. This can be done more effectively and safely than standard chemotherapy, which is delivered intravenously, and can’t be targeted. HIPEC also generally has fewer side effects than traditional chemotherapy.

Doctors called surgical oncologists perform both tumor removal surgeries and HIPEC treatments. Penn Medicine is among only a few academic medical centers offering tumor removal surgery with HIPEC. Our experienced surgical oncologists have offered the HIPEC procedure since 2011 and have successful surgical track records that cover decades of medical practice.

People diagnosed with appendiceal cancer, colorectal cancer, stomach cancer, ovarian cancer, primary peritoneal mesothelioma, or pseudomyxoma peritonei are most frequently treated with a HIPEC procedure if the cancer hasn’t spread beyond the abdomen.

Your Penn Medicine provider may recommend HIPEC surgery based on the following factors:

• The type of tumor
• Stage of cancer
• Tumor’s growth rate
• Your overall health

Cancer treatment with HIPEC is complex and requires a specialized and experienced team to be done safely and effectively. At Penn Medicine, our expert surgical and medical oncologists, anesthesiologists, pathologists, radiologists, and critical care specialists work together through each stage of your treatment, from diagnosis through recovery.

Before your HIPEC surgery, your doctor will explain how the procedure is done and give you time to ask questions. Your care team will review your medications with you, discuss your health history, and let you know how to prepare for surgery. You may also be required to have preoperative tests and evaluations—such as imaging or heart tests—to assess your overall health for surgery.

On the day of your procedure, you can expect the following:

• You’ll have anesthesia with sedation, so you’re asleep and pain-free during surgery.
• The surgeon surgically removes your tumor. Once the tumor has been removed, HIPEC treatment begins.
• The surgeon heats chemotherapy to about 107 degrees Fahrenheit and uses a catheter to circulate it throughout your abdomen. It’s like a chemotherapy bath for your abdominal cavity.
• Your care team takes special precautions to keep your body temperature within a safe range during HIPEC treatment.
• Once complete, the chemotherapy is drained, and your abdomen is rinsed with saline.
• The HIPEC procedure lasts about 90 minutes. The surgery and HIPEC procedure together typically lasts between six to nine hours.
• After the surgery, you’ll be monitored closely as you wake up from anesthesia. Pain management will be provided to help you recover.

Once you’re discharged from the hospital, it’s important to attend all your follow-up appointments with your surgical team so they can monitor your recovery and discuss any additional care that may be needed.

After HIPEC, patients generally stay in the hospital for seven to 10 days. During that time, your digestive system will need to recover from the intense dose of chemotherapy you received. You’ll get your nutrition through a feeding tube or IV while you recover.

Because the procedure involves a one-time, targeted dose of chemotherapy, there is minimal chemotherapy exposure to the rest of your body. This means that the typical chemotherapy side effects, such as hair loss and mouth sores, can be avoided.

Recovery from HIPEC surgery is a gradual process, and it may take several weeks to months to fully regain your strength and resume normal activities. Your care team will provide guidance on when it's safe to return to work, exercise, and other daily activities. Remember to be patient with yourself and give your body the time it needs to heal. If you have concerns or questions during your recovery, don't hesitate to contact your Penn provider for guidance and support.

It’s common for people to come to the Hospital of the University of Pennsylvania from outside of the region for HIPEC treatment. Talk with your Penn Medicine care team if you have questions about patient and visitor information. In addition, rest assured that your Penn provider will form a close relationship with your local oncologist to keep them informed of your care. Together, we’ll plan your surgery, begin your recovery, and transition your care to your local provider. If your local hospital or oncologist doesn’t have the expertise or resources to treat your specific case, we’ll continue to provide you with the advanced medical oncology care you need.