Hipec Surgery: Purpose, Procedure, and Benefits and Side Effects

A type of cancer treatment is called hyperthermic intraperitoneal chemotherapy (HIPEC), which is a two-step process and is often employed to treat abdominal malignancies. The term 'hyperthermic' refers to an unusually high temperature, whereas 'Intraperitoneal' refers to location within the abdominal cavity. At the time of cancer surgery, HIPEC entails heating chemotherapy medications and circulating them through the abdominal cavity.

A heated chemotherapeutic chemical injection is administered into the abdomen to destroy any leftover malignant cells after the surgical removal of cancerous tumors through cytoreductive surgery.

HIPEC surgery is majorly used to treat cancer that has spread past the primary organ to the lining of the abdominal cavity (peritoneum), treating which can be challenging with conventional chemotherapy. In such a scenario, massive doses of chemotherapy are injected into the belly to treat the abdominal cancers.

The HIPEC is a two way process and has no types or subtypes. It is a noble approach to treat advanced and metastasis cancer, especially of the abdomen and chest. The success rate of the procedure has popularized it among surgeons in place of other cancer treatment therapies like chemo and radiation therapy.

This cutting edge surgery can benefit patients in so many ways;

• High doses of medication can be administered straight to the belly by HIPEC procedure, where conventional chemotherapy treatments are inadequate
• A higher chemotherapy dose that can kill more cancer cells
• A single therapy session as opposed to several sessions spread out across several weeks
• The typical negative effects of chemotherapy can be prevented as there is limited exposure to the rest of the body with the same impact
• Beneficial for patients with inoperable or advanced-stage cancer since it enhances long-term results and increases therapy alternatives.

HIPEC surgery is often used by medical professionals to treat various kinds of cancers that affect the chest or abdomen. HIPEC may be an option for treating:

• Appendix cancer: Also known as appendiceal cancer, it develops in the appendix (part of the colon and intestines)
• Colon and rectal cancer: Colorectal cancer in any part of your large intestine (colon) or the passageway that connects your colon and anus (rectum)
• Gastric (stomach) cancer: Gastric cancer or stomach cancer, affecting the inner lining of your stomach
• Ovarian cancer: Ovarian cancer in the ovaries, which create hormones and eggs in women
• Peritoneal cancer: Cancer of the tissues lining your belly, or peritoneal cancer
• Mesothelioma: A cancer of the lining of the chest or abdomen that is frequently caused by asbestos exposure
• Soft tissue sarcomas or the cancer of connective tissues
• Adrenal cancer: Wilms’ tumor, a type of renal/ kidney cancer that predominantly affects children
• Liver cancer: Liver malignancies like hepatocellular carcinoma
• Pancreatic cancer: Cancer that begins in the tissues or cells of pancreas

HIPEC can also be used to treat malignant ascites, a fluid buildup in the abdominal cavity that can occur with some types of abdominal cancer.

The risks of a HIPEC are generally the same as those of any chemotherapy or radiation therapy, including;

• Intestinal leakage
• Renal failure
• Pancreatic inflammation
• Sepsis
• Reduction in bone marrow and blood cells
• Recurrence of cancer

Despite the risks, a HIPEC surgery can be a good choice for people with advanced abdominal or chest cancer. The chances of countering the risks and side effects can also be ignored or reduced if the surgery is done by an expert at Pristyn care.

You'll be instructed to follow a few instructions the night before your procedure to guard against infections and complications:

• The day before surgery, you can eat a light breakfast and lunch but must limit your fluid intake the rest of the day to only clear liquids
• The day before surgery, beginning at midday, you will sip a special beverage that will empty your bowels of all solid matter
• Antibiotics will be supplied to you three times a day at 1, 2, and 10 p.m. to prevent infection
• The night before your procedure, you'll be told to take a shower using antibacterial soap
• Your team will provide you with a fluid high in carbohydrates to help you increase strength and speed up recovery. You'll consume it twice: once before bed and once two hours prior to operation
• Leave all your expensive and pricey items, such as jewelry and watches, at home
• Make a list of each medication currently being taken
• Pack robe, slippers, pajamas, and casual attire
• Shampoo, toothpaste, comb, and other toiletries as you may need to stay for a long time in the hospital.

HIPEC is often done by surgeons after debulking surgery, which removes any malignancies that are visible from your abdominal cavity. These tumors could be in the ovaries, stomach, or intestines. The procedure is performed through tiny incisions made in the abdomen. HIPEC is typically performed by the doctor right after the surgery, while the patient is still in the operating room and under anesthesia.

There are numerous steps in the HIPEC process, that could be easily understood with what happens before, during and after procedure;

Your body will be wrapped in a cooling blanket by your medical team during the treatment to maintain a safe temperature

In a unique apparatus known as a perfusion machine, chemotherapeutic medications will be heated to 39°C (103°F)

The length of HIPEC procedure might range from 8 to 10 hours, however, it may vary based on how far the cancer has spread throughout the abdomen. It could take longer to treat cancer that has advanced in stages. The whole procedure can be divided into three different stages;

• Exploration: Your surgeon will first examine the area to find any tumors and decide what needs to be removed,
• Cytoreductive surgery: The surgeon will subsequently do cytoreductive surgery to remove any malignancy that is visible
• HIPEC: The surgeon will employ HIPEC, commonly known as hot chemo, to eradicate any undetectable cancer cells that may still exist. A heated sterile liquid will have chemotherapy added to it, which they will then inject through catheters from the perfusion machine into your abdomen. Your body will circulate the hot chemotherapy medications for roughly one to one and a half hours, the perfusion machine has administered to your belly. Your medical professionals will take out the catheters after the procedure is over, clean your abdomen with a salt solution, and then sew up the incision To make sure that the medication reaches every part of your abdominal cavity during therapy, your healthcare professional will physically rock you back and forth a few times.

The doctor will use one of the following techniques to close your incision once the procedure is finished:

• Surgical glue and dissolvable sutures: These stitches naturally disappear or dissolve
• Staples: Seven to ten days following your surgery, your staples will be removed
• A VAC dressing: This vacuum-sealed covering could aid in reducing the risk of infections. Until it is taken by hospital staff, you typically wear it for five to seven days

• Your medical professionals will take out the catheters after the procedure is over, clean your abdomen with a salt solution, and then sew up the incision
• After surgery, the patient is held in intensive care for one to two days before moving to the ward for three to five days
• The patient is then examined for indications of dehydration and electrolyte and blood glucose levels are measured. Up until they are stabilized and the patient is able to eat solid meals and have bowel movements
• Patient's fluid electrolytes are also being closely watched
• Your heart rate, blood pressure, and oxygen levels will all be monitored by devices that are attached to your body
• A nose tube or a face mask will be attached to provide oxygen to you
• To drain your stomach fluids, a tube will be inserted from your stomach and out your nose
• A catheter will be used to drain your bladder
• You might not be able to eat during your early recovery phase depending on the complexity of your surgery. Nutrition, medications, and fluids can be given to you intravenously (IV) or through a feeding tube
• A flexible band will be wrapped over your abdomen to support your muscles
• A drainage tube to drain fluid from your abdomen may be present
• Patient is advised to stay in the hospital for four to fourteen days following treatment to recover

In India, HIPEC surgery typically costs INR 4,00,000. However, as with any cancer operation, the precise cost may vary a bit based on the stage of your cancer, your choice of surgeon, their level of experience, the location of the hospital, as well as additional medical and non-medical costs.

The following is a summary of the approximate costs for HIPEC surgery in several Indian metropolises:

The costs may range based on the hospitals in other cities and can range somewhere between INR 4,85,000 to INR 6,00,000. The price of HIPEC procedure in Hyderabad is somewhere between INR 5,50,000 to 6,25,000, in Delhi the procedure can cost INR 4,85,000 to 5,65,000, in Mumbai it can range from INR 5,00,000 to 5,75,000, whereas in Chennai it can vary from INR 5,25,000 to 6,00,000, Kerala somewhere around INR 5,50,000 to 6,25,000, Ahmedabad approximately INR 5,65,000 to 6,35,000, and in Goa from INR 5,65,000 to 6,35,000, while in Chandigarh it can cost between INR 5,40,000 to 6,10,000, and in cities like Bangalore and Noida it can cost between INR 5,40,000 to 6,10,000 and INR 4,85,000 to 5,65,000, respectively.

A lot of variables may affect the cost of surgery. Along with tier-1 or tier-2 cities; hospital or clinic brand names, the fees of the treating consultant, admission fee, type of the surgery, post-surgical complications that are involved, admission room that you opted for, may also have an influence on hospital billing expenses.

The total cost of the procedure may also be impacted by the number of diagnostic tests performed. The entire cost of the surgery may decrease based on the patient's insurance plan.

In the initial days following HIPEC surgery, you will get fluids, food, and medication through your IV that is intravenously through the veins. An extremely dry mouth is a common side effect after surgery for which you will receive ice chips from your care team to assist you with this. Your return to a normal solid diet will ensure your discharge. Your team will provide you with some advice on what to eat and avoid for your faster recovery post-HIPEC, that may include;

• Lots of water
• Fish
• Meat
• Eggs
• Dairy
• Tofu
• Tempeh
• Vegetables
• Fruit
• Nuts
• Nutty butter
• Beans
• Whole wheat bread
• Pasta
• Beans

HIPEC is an effective treatment option for many abdominal and chest cancer patients and has a higher success rate than the other advanced oncology surgical procedures. HIPEC is elected as one of the effective cancer treatments in comparison to traditional chemotherapy or radiation treatment.

Even though high and concentrated doses of warm chemotherapy chemicals are pumped directly into your belly during HIPEC, it is not as harmful. This is due to the drugs not moving through your body as much as chemotherapy administered via an IV because they are not injected into your bloodstream. Also, the high temperature drugs are found to be effective against cancer cells as normal and healthy cells are immune against high temperatures.

The whole procedure is done under general anesthesia, hence the surgery itself isn’t painful. However, after HIPEC, that is done soon after cytoreductive surgery (CRS), the patient might experience some pain that can be managed with medications. The pain may go away in a few weeks as the incisions heal.

Depending on the amount of your HIPEC procedure, recovery could take four to twelve weeks. You will have a follow-up appointment with your oncologist (a medical professional who specializes in cancer) in one to two weeks after leaving the hospital.

Your oncologist will continue to check on your cancer on a regular basis. Sometimes more chemotherapy is not necessary. Additional IV chemotherapy is advised for various illnesses. Your doctor will decide on this, once more.

Most common side effects, of HIPEC procedure includes;

• Nausea
• Vomiting
• Discomfort
• Weight loss
• Depression
• Bloating
• Diarrhea or constipation
• Fatigue
• Sleep issues.

Your team will recommend a number of home care guidelines to assist you in continuing your recovery at home, such as;

• Consume a lot of calories to increase energy and a lot of protein to aid in recovery
• Eat small, frequent meals throughout the day if you tend to feel hungry or full quickly. Start out cautiously and gradually return to your regular diet
• Maintain regular bowel movements and don't go more than three days without it. Use stool softeners since painkillers impede your bowel movements
• Drink a lot of fluids all day long to stay hydrated
• Stay active throughout the day by taking short walks; however, stay away from exercises that work your core and abdominal muscles. Walking will restore your vitality, stop blood clots, and improve your general wellbeing
• As long as your job doesn't involve heavy lifting, you can return to the office in approximately a month
• Shower is acceptable, but bathing, swimming or using a hot tub shouldn't be done until the incision has healed
• After being released from the hospital, spend a few days close to your house
• For a postoperative appointment or if a problem develops, you must see your surgeon
• You will have a follow-up appointment about a week after you leave the hospital. Your surgeon will evaluate your healing and, if necessary, modify your care.

HIPEC is an advanced procedure that is among the best available options to treat malignancies of abdomen and chest. This two-way procedure is done when undergoing cancer surgery. All observable cancerous tumors are taken out and then chemotherapy medications heated to 103 degrees Fahrenheit (42 degrees Celsius) are circulated throughout your body as part of the HIPEC cancer treatment.

The heated chemo medicines are well absorbed by the body, hence destroying comparatively more cancerous cells than any traditional chemo or radiation therapy. Full recovery post HIPEC often takes three months or more.