Is HIPEC really necessary?

Why HIPEC?

The greatest benefit of HIPEC is seen in pseudomyxomaperitonei, colorectal cancer and mesotheliomas. When treated with intravenous chemotherapy alone, these patients survive for few months to a couple of years. Cytoreductive surgery and HIPEC has shown to prolong survival in these cancers. Its role in ovarian and stomach cancer is under investigationbut  more and more centres are using it for treatment since the results are promising

What is the aim of rinsing the abdominal cavity with heated chemotherapy?

The rinsing of the abdominal cavity with heated chemotherapy aims to kill the microscopic tumor implants, that are invisible to the naked eye, and that remain afterremoval of the visible tumor. If left untreated these cells implant  at the operative site and the surrounding regions and produce a tumor recurrence.  Destroying these tumor cells reduces the chances of the the cancer coming back.

Chemotherapy which has been poured into the abdominal cavity hardly leaves the abdomen, causing much less secondary effects to the rest of the body than the same dose of chemotherapy given intravenously. This way, a much higher amount of chemotherapy can be given, exposing tumor cells to drug concentrations that are upto 100 times higher than for intravenous chemotherapy. Furthermore, by heating this chemotherapy to temperatures between 41-43° Celsius, the tumor-killing effect is increased as well as the depth of penetration intothe small tumor remnants.

After HIPEC is systemic (intravenous)  chemotherapy required?

After HIPEC in low grade appendicular cancers, pseudomyxomas and low grade mesotheliomas, further chemotherapy may not be needed. In all other cases it is necessary to give further intravenous chemotherapy.