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PERITONEAL SURFACE ONCOLOGY
HIPEC
Hyperthermic Intraperitoneal Chemotherapy
A precision surgical-oncological procedure that delivers heated chemotherapy directly to the abdominal cavity, eliminating peritoneal cancer cells that systemic therapy cannot reach.
Ovarian Cancer
Appendix / PMP
Gastric Cancer
Mesothelioma
41–42°C
Chemotherapy Temperature
60–90 min
Perfusion Duration
CRS + HIPEC
Combined Procedure
ESSO Trained
European Fellowship, Hannover
WHAT IS HIPEC?
Chemotherapy Delivered Directly Where Cancer Lives
HIPEC (Hyperthermic Intraperitoneal Chemotherapy) is a specialised cancer treatment in which heated chemotherapy drugs are circulated directly inside the abdominal cavity immediately after cytoreductive surgery (CRS). Unlike systemic chemotherapy, which travels through the bloodstream, HIPEC targets cancer cells on the peritoneum, the lining of the abdomen, at concentrations far higher than oral or intravenous chemotherapy can safely deliver.
The heat serves a dual purpose: it enhances the penetration of chemotherapy drugs into cancerous tissue, and it directly damages cancer cells that are more sensitive to high temperatures than normal cells. This combination makes CRS + HIPEC a potentially curative, not merely palliative, option for carefully selected patients with peritoneal surface malignancies.
The procedure was pioneered in the 1990s and has since become the international standard of care for peritoneal metastases in many cancer types, supported by landmark randomised controlled trials.
How HIPEC Works
Cytoreduction (CRS)
All visible tumour deposits are surgically removed from the peritoneum and affected organs. The goal is no visible remaining disease (CC-0 resection).
Perfusion Circuit
Catheters are placed in the abdomen and connected to a perfusion machine that heats chemotherapy solution to 41–42°C.
Heated Perfusion (60–90 min)
The heated chemo solution (cisplatin, mitomycin-C, or oxaliplatin) is continuously circulated for 60–90 minutes, bathing all peritoneal surfaces.
Closure & Recovery
The solution is drained, the abdomen closed, and the patient moves to ICU for close monitoring. Recovery is typically 7–14 days in hospital.
INDICATIONS
Cancer Types Treated with HIPEC
HIPEC is recommended for peritoneal metastases from specific cancer types where the disease is confined primarily to the abdominal cavity with limited systemic spread.
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Colorectal Cancer with Peritoneal Metastases
When colorectal cancer spreads to the peritoneum, CRS + HIPEC has shown survival benefit over systemic chemotherapy alone in randomised trials.
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Ovarian Cancer (Primary & Recurrent)
HIPEC is used both in primary debulking and interval debulking surgery for ovarian cancer, supported by the landmark van Driel et al. NEJM trial.
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Appendix Cancer / Pseudomyxoma Peritonei (PMP)
PMP is a rare condition arising from appendix tumours producing mucin throughout the abdomen. CRS + HIPEC is the standard curative treatment.
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Gastric Cancer with Peritoneal Spread
Selected patients with gastric peritoneal metastases may benefit from HIPEC, particularly in conjunction with D2 gastrectomy in specialised centres.
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Malignant Peritoneal Mesothelioma
A rare cancer of the peritoneal lining. CRS + HIPEC offers the best outcomes, with median survival exceeding 5 years in optimal candidates.
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Selected Other Peritoneal Tumours
Certain sarcomas, GIST with peritoneal spread, and other primary peritoneal tumours may be evaluated on a case-by-case basis at tumour board.
CANDIDACY
Am I a Candidate for HIPEC?
Not every patient with peritoneal metastases is suitable for HIPEC. Candidacy is carefully assessed through a multidisciplinary tumour board review, imaging, performance status evaluation, and sometimes diagnostic laparoscopy.
Limited peritoneal extent (low PCI score)
The Peritoneal Cancer Index (PCI) score is used to quantify tumour spread. A lower PCI is associated with better outcomes.
No or limited extra-abdominal disease
Disease should be primarily confined to the peritoneal cavity, not widely spread to lungs, liver parenchyma, or distant lymph nodes.
Good performance status (ECOG 0–1)
CRS + HIPEC is a major operation requiring the patient to be medically fit to tolerate an extended procedure and recovery.
Chemosensitive tumour type
Tumour biology and response to prior systemic therapy provide important information about likely benefit from HIPEC chemotherapy agents.
Every case is reviewed individually. If you have been told that your cancer has spread to the peritoneum, a specialist opinion from Dr. Imaduddin can clarify whether HIPEC is appropriate for you.
DR. IMADUDDIN’S EXPERTISE
HIPEC Expertise Trained at the European Centre of Excellence
🇩🇪 ESSO FELLOWSHIP · HANNOVER, GERMANY
Dr. Mohammed Imaduddin completed his ESSO (European Society of Surgical Oncology) Fellowship in Peritoneal Surface Malignancy, HIPEC and PIPAC under Prof. Dr. Beate Rau at University Hospital Hannover, one of the world’s foremost centres for peritoneal oncology and a globally recognised authority in HIPEC surgery.
CRS + HIPEC Operative Experience
Trained in the full technical spectrum of HIPEC perfusion techniques including open (Coliseum), closed, and semi-closed methods.
Peritoneal Cancer Index Assessment
Expert in PCI scoring, diagnostic laparoscopy for peritoneal disease evaluation, and multidisciplinary case selection.
HIPEC Drug Protocols
Experience with cisplatin (ovarian), oxaliplatin + 5-FU (colorectal), and mitomycin-C based protocols tailored to tumour type.
FREQUENTLY ASKED QUESTIONS
Common Questions About HIPEC
Is HIPEC available in Hyderabad?
Yes. Dr. Mohammed Imaduddin performs CRS + HIPEC in Hyderabad through CION Cancer Clinics, making this internationally trained expertise available to patients in Telangana, Andhra Pradesh, and across South India.
How long is the surgery and recovery?
CRS + HIPEC is typically a 6–12 hour procedure depending on the extent of disease. Hospital stay is usually 7–14 days, with full recovery taking 4–8 weeks. ICU stay for 1–3 days post-operatively is standard.
What are the risks of HIPEC?
As a major operation, CRS + HIPEC carries risks including infection, bleeding, anastomotic leak, and chemo-related side effects (kidney, blood counts). These are managed by experienced perioperative teams. Morbidity and mortality rates have improved significantly in high-volume centres.
Can HIPEC cure peritoneal metastases?
For selected cancers, particularly appendix PMP and peritoneal mesothelioma, CRS + HIPEC can result in long-term cure or very prolonged survival. For colorectal and ovarian peritoneal metastases, it significantly improves survival compared to chemotherapy alone, with 5-year survival rates of 30–45% in optimal candidates.
I have been told HIPEC isn’t possible. Should I seek a second opinion?
Yes, absolutely. Candidacy for HIPEC depends heavily on the experience and specialisation of the evaluating surgeon. Many patients initially told they are not candidates have subsequently undergone successful CRS + HIPEC at specialised centres. Dr. Imaduddin offers second opinion consultations specifically for peritoneal disease cases.
Find Out If HIPEC Is Right for You
Dr. Imaduddin offers specialist consultations for peritoneal cancer cases, including second opinions for patients who have been told HIPEC is not an option. Every case is reviewed with care.