Cytoreductive Surgery and HIPEC

Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a treatment approach designed for cancers that have spread to the lining of the abdominal cavity, known as peritoneal carcinomatosis. It combines surgery to remove visible tumors and heated chemotherapy to eliminate remaining cancer cells. This method is commonly used for cancers like colorectal cancer, ovarian cancer, gastric cancer, and peritoneal mesothelioma.

Symptoms

Peritoneal carcinomatosis may present with various symptoms depending on the affected organs:

Abdominal pain or discomfort
Abdominal swelling (ascites) due to fluid buildup
Bloating
Unintended weight loss
Changes in bowel habits (diarrhea, constipation)
Nausea or vomiting
Fatigue
Loss of appetite

Causes:

The primary cause of the need for Cytoreductive Surgery and HIPEC is the spread of cancer to the peritoneum (the lining of the abdomen). Cancers that commonly cause peritoneal carcinomatosis include:

Colorectal cancer
Ovarian cancer
Gastric (stomach) cancer
Appendiceal cancer
Peritoneal mesothelioma

Treatment:

Cytoreductive Surgery (CRS):

The goal of CRS is to remove all visible tumors within the abdominal cavity. This may involve resecting parts of organs (like the colon, ovaries, or spleen) and removing affected sections of the peritoneum.
The more complete the removal of the tumors, the better the patient's chances of survival. Surgeons aim for a "complete cytoreduction," where no visible tumors remain.

Hyperthermic Intraperitoneal Chemotherapy (HIPEC):

After the surgery, a heated chemotherapy solution is circulated in the abdominal cavity for 60-90 minutes. The chemotherapy is heated to 41-43°C (105-109°F), which enhances the effectiveness of the drugs.
The heated solution helps destroy microscopic cancer cells left behind after surgery and can penetrate deeper into tissues compared to standard chemotherapy.
HIPEC minimizes the systemic side effects of chemotherapy because the drugs are mostly confined to the abdominal cavity rather than affecting the whole body.

Benefits:

Localized treatment: HIPEC directly targets the cancer in the abdominal cavity, reducing the risk of recurrence.
Improved survival: In certain cases, particularly for peritoneal carcinomatosis of colorectal or ovarian origin, this treatment has been shown to improve overall survival rates.
Reduced chemotherapy side effects: Since the chemotherapy is applied locally, systemic side effects are minimized.

Risks and Side Effects:

Surgical risks: CRS is a major procedure that can lead to complications such as bleeding, infection, or damage to organs.
Postoperative recovery: Recovery can take weeks to months, with possible complications like infection, bowel obstruction, or poor wound healing.
HIPEC side effects: Though less systemic, HIPEC can cause nausea, fatigue, abdominal pain, or issues related to the surgery.