HipecEdit
HiPEC, or Hyperthermic intraperitoneal chemotherapy, is a targeted cancer treatment that combines cytoreductive surgery with the intraoperative administration of heated chemotherapy into the peritoneal cavity. The goal is to remove visible tumor mass and then eradicate microscopic residual cancer cells that often drive recurrence on the lining of the abdomen. The heated infusion is circulated for a period of time while the abdomen is temporarily isolated, aiming to maximize local anti-tumor effects while limiting systemic exposure. HiPEC is most commonly considered for cancers that spread primarily within the peritoneum, including colorectal cancer with peritoneal metastases, ovarian cancer, gastric cancer, mesothelioma, and certain appendiceal tumors, among others peritoneal carcinomatosis.
The procedure is carried out in specialized centers and requires a multidisciplinary team, including surgical oncologists, anesthesiologists, critical care specialists, and nursing staff knowledgeable about complex intraperitoneal therapies. HiPEC represents a distinct approach from standard systemic chemotherapy, as it delivers a high concentration of anti-cancer drug directly to the abdominal surfaces with a controlled heat stimulus, potentially enhancing drug uptake by tumor cells and augmenting the cytotoxic effect of the chemotherapy. The technique relies on exacting protocols for temperature, duration, and drug choice, and it is typically performed in the context of an extensive operation known as cytoreductive surgery (CRS) followed by intraperitoneal chemotherapy cytoreductive surgery.
In discussing the use of HiPEC, it is important to recognize both its potential benefits and its limits. Proponents point to improved local disease control and, in carefully selected patients, longer survival relative to approaches that do not combine debulking with intraperitoneal chemotherapy. Critics note that the quality and consistency of evidence vary by cancer type, that benefits may be modest in some settings, and that the procedure carries substantial risks, including organ toxicity, infectious complications, and long rehabilitation times. Because of these factors, patient selection – guided by tumor biology, disease extent, and overall health – is central to the decision to pursue HiPEC. Guideline bodies in different regions have issued nuanced recommendations that stress selective use within experienced programs, rather than broad, routine application ESMO, NCCN.
Medical use
Indications
HiPEC is used in the management of select cancers with peritoneal involvement. Common indications include colorectal cancer with peritoneal metastases, ovarian cancer with peritoneal spread, certain gastric cancer cases, and cancers such as pseudomyxoma peritonei or some appendiceal cancer where disease is confined to the peritoneal cavity. The aim is to reduce tumor burden and address microscopic disease that is not detectable by imaging but drives relapse.
Procedure
The overall treatment sequence typically involves CRS to remove visible tumor deposits, followed by HiPEC. The intraoperative perfusion uses a closed- or open-abdomen technique to circulate heated chemotherapy solution within the peritoneal cavity for a defined period, with drug choices including agents such as cisplatin or mitomycin C depending on the cancer type and institutional protocol. Temperature is carefully regulated, generally in the low 40s Celsius, to maximize anti-tumor activity while limiting systemic toxicity. The approach requires specialized equipment and postoperative support, including intensive care and close monitoring for potential complications hyperthermia.
Outcomes and evidence
Evidence on HiPEC outcomes varies by tumor type and patient selection. Some randomized trials and observational studies report improvements in local control and, in select settings, survival, particularly when aggressive cytoreduction is feasible and complete or near-complete tumor removal is achieved. In other contexts, benefit signals are less clear or require longer follow-up to define. Because outcomes are highly dependent on tumor biology, disease extent, and center experience, comprehensive interpretation relies on the alignment of evidence, patient preferences, and resource considerations. Ongoing trials and meta-analyses continue to refine the understanding of where HiPEC delivers the most value clinical trials.
Risks and safety
HiPEC carries risks associated with major abdominal surgery plus intraperitoneal chemotherapy. Potential complications include kidney injury, bone marrow suppression, infections, anastomotic leaks, and prolonged recovery. Centers emphasize stringent selection criteria, meticulous surgical technique, and coordinated perioperative care to mitigate risk. The safety profile and acceptable risk-to-benefit ratio depend on tumor type, disease burden, and institutional expertise nephrotoxicity.
Alternatives and complements
For many patients, alternative strategies include systemic chemotherapy alone, targeted therapies, immunotherapy where appropriate, or palliative care focusing on quality of life. In some cases, CRS without intraperitoneal chemotherapy or other regional therapies may be considered. The choice among options is influenced by tumor biology, prior treatments, patient health status, and preferences about treatment burden and expected outcomes oncology.
Controversies and debates
Evidence quality and patient selection
The core debate surrounding HiPEC centers on the strength and generalizability of evidence. Supporters argue that when applied in high-volume centers to well-selected patients, HiPEC can meaningfully improve disease control and survival for certain peritoneal surface malignancies. Critics contend that some indications lack robust randomized data and that favorable results may reflect center experience, selection bias, or the effects of extensive cytoreductive surgery rather than HiPEC alone. This tension underscores the principle that value in medicine comes from delivering proven benefits to the right patients, rather than expanding use beyond what evidence supports. See ongoing discussions in major oncologic guidelines and trials for peritoneal malignancies NCCN, ESMO.
Cost, access, and health policy
HiPEC is resource-intensive, requiring specialized facilities, equipment, and multidisciplinary teams. Critics emphasize that high upfront costs and the need for regional or national investments in centers can create access disparities, particularly for patients outside major urban areas. Proponents argue that high-quality, high-volume programs can achieve better outcomes and may lower long-term costs by reducing recurrence and the need for further systemic therapies. The debate intersects with broader questions about value-based care, health coverage, and how to align incentives with patient-centered outcomes cost-effectiveness.
Standards of care and regional variation
Given the heterogeneity of cancers treated with HiPEC, regional guidelines differ in how strongly they endorse the procedure. This reflects differences in patient populations, availability of expert centers, and interpretations of the evidence. In some jurisdictions, HiPEC is presented as an option within a menu of tailored therapies for peritoneal disease, while in others it is recommended only within high-volume peritoneal surface malignancy programs. The emphasis is on matching therapy to disease course and patient goals, rather than adopting a universal standard of care guidelines.
Training and centers
HiPEC programs are concentrated in centers with dedicated expertise in peritoneal surface malignancies. Training emphasizes CRS techniques, perioperative management, intraperitoneal chemotherapy administration, and multidisciplinary care pathways. Volume and experience correlate with outcomes, reinforcing the case for centralized, specialized programs. Centers often publish data on patient selection criteria, institutional protocols, and long-term results to inform practice and policy peritoneal surface malignancy.