Cytoreduction with HIPEC

Quick Summary

Cytoreduction with HIPEC is a curative surgical treatment for peritoneal mesothelioma. The procedure involves two parts: 1) removing the abdominal lining and any visible tumors; and 2) applying a heated chemotherapy treatment to the abdominal cavity to kill remaining cancer cells.

Cytoreduction with HIPEC Overview

Peritoneal mesothelioma is a rare form of the disease (accounting for 10–25% of cases), caused by ingesting asbestos fibers. The sharp fibers get stuck in the lining of the abdomen (pericardium) where mesothelioma later develops. It is an aggressive disease requiring an equally aggressive treatment plan.

In many cases, cytoreduction (removal of the peritoneum and visible tumors) with HIPEC (hyperthermic intraoperative chemotherapy) is the best treatment option. For the right patients, this curative two-pronged approach has proven to extend life expectancy by five or more years.

The operation is most effective for patients with early-stage mesothelioma, as cancer has not metastasized (spread) beyond the chest cavity. Patients in advanced stages may also be candidates for curative peritoneal surgery, or they may benefit from the symptom relief of a palliative tumor-clearing operation.

The mortality rate is relatively low at 1–5%. The most common side effects involve the digestive system. Cytoreduction is a lengthy procedure at 10+ hours, so some patients may be at increased risk of complications associated with general anesthesia.

Who is Eligible for Cytoreduction with HIPEC?

Patients with early-stage peritoneal mesothelioma are ideal candidates for cytoreduction with HIPEC. Some patients with advanced stages may be eligible if cancer has not spread beyond the chest cavity. Little or no metastasis offers the surgeon a better chance of eliminating all tumors and cancer cells—and therefore mitigating recurrence (when the mesothelioma comes back after being removed).

You must also be in good overall health to handle the complex procedure.

Some considerations include:

  • Age—In general, younger patients are better surgery candidates than older patients
  • Gender—Women often have better survival and recovery rates than men
  • Other health conditions (especially heart conditions)
  • General health and fitness level

Peritoneal mesothelioma symptoms can be vague, and patients are often not diagnosed (or misdiagnosed) until cancer has spread too far to undergo curative surgery. It is critical to see your doctor immediately after noticing potential mesothelioma signs and symptoms.

Benefits of Cytoreduction with HIPEC

The main goal of the surgery is to prevent metastasis and recurrence by removing all visible tumors during cytoreduction and killing any remaining cancer cells with HIPEC (a complete cytoreduction). Combining these two treatments have proven to give patients the best possible prognosis.

If a complete cytoreduction is not possible, you can still benefit from the procedure in a palliative nature. Removing tumor masses alleviates pain and troublesome bowel symptoms, and improves the overall quality of life.

Cytoreduction with HIPEC Procedure

Cytoreduction is a major surgery involving important medical processes before, during, and after the operation. Patients should understand the steps involved:

Before Surgery

Doctors will want to confirm that you are healthy enough to undergo the procedure before operating. They will order routine tests to measure cardiac, pulmonary, and other vital functions, and will scan your abdomen to confirm tumor size and location.

Patients typically stay in the hospital the night before surgery. Doctors will ask you to prepare your bowels by drinking an electrolyte solution before the procedure (as done when preparing for a colonoscopy).

During Surgery

Cytoreduction with HIPEC is performed under general anesthesia. The surgeon makes an incision along the front of the abdomen to access the abdominal cavity. The surgeon then removes the peritoneum and searches the abdominal cavity for any visible tumors.

Cytoreduction is a highly technical surgery that takes approximately 10 hours to complete. Depending on the location of the tumors, the surgeon may have to remove small portions of other organs or those which are non-essential (such as the appendix) to gain access.

During the HIPEC stage, the surgical team bathes the abdominal organs in a heated chemotherapy treatment to kill remaining cancer cells. Since the chemotherapy drugs are applied directly to the organs and not administered through the bloodstream, doctors can use higher doses. HIPEC treatment lasts for one to two hours, at which point the operation is complete and the incision is stitched closed.

Recovery

Patients remain in the hospital for one to two weeks following surgery, depending on how their body reacts to the cytoreduction and HIPEC treatment. An IV administers fluids, medications, and nutrition supplements, and doctors monitor you closely for signs of post-operative complications.

At-home recovery continues for another two to four weeks. During this time, you will receive medication and nutrition supplements by pill or IV to help your digestive system recover. Most patients can resume normal activity within three to six months after surgery.

Cytoreduction with HIPEC Life Expectancy and Survival

The average life expectancy for peritoneal mesothelioma patients is 12 months. However, patients who undergo cytoreduction with HIPEC may extend their life by another four or five years, with some patients living a further ten years or more.

Peritoneal mesothelioma is a rare form of the disease, and researchers continue to gather statistics that provide a clearer representation of patients’ prognosis. Life expectancy rates are also skewed in that most patients are diagnosed at later stages of life when they are approaching the life expectancy of an otherwise healthy person.

Risks & Side Effects of Cytoreduction with HIPEC

Cytoreduction with HIPEC is a complex surgery involving several organs in the abdominal cavity.

While only the top surgeons in large medical centers perform the operation, patients should understand the possible risks and side effects, including:

  • Cardiac complications
  • Digestive system complications
  • Internal bleeding
  • Infection
  • Blood clotting

The surgery’s length may also increase the probability of risks and side effects associated with general anesthesia, including:

  • Nausea, vomiting, and dizziness
  • Chills
  • Temporary confusion
  • Sore throat (from removal of the breathing tube)
  • Muscle discomfort
  • Itching

And in rare cases:

  • Malignant hyperthermia (a rare but potentially fatal reaction to anesthesia causing rapid fever)
  • Delirium (confusion, disorientation, and difficulty with memory recall, occurring up to a week after surgery)
  • Cognitive dysfunction (patients with some existing medical issues including heart and lung disease, Alzheimer’s and Parkinson’s disease may be at increased risk for long-term memory loss and impairment of learning ability)

The mortality rate for cytoreduction with HIPEC is 1–5%. This rate and the probability of experiencing a complication continue to decrease as new research and medical advancements make the surgery safer.

Cytoreduction with HIPEC is a curative surgery that may extend your life expectancy by years. If you have been diagnosed with peritoneal mesothelioma, it is crucial that you seek a second opinion right away from a qualified mesothelioma specialist. Together, you can determine the optimal treatment plan for your specific case.

View Author and Sources
Author

Sources
  1. American Society for Anesthesiologists, “Effects of Anesthesia.” Retrieved from https://www.asahq.org/whensecondscount/patients%20home/preparing%20for%20surgery/effects%20of%20anesthesia. Accessed on February 15, 2018.
  2. European Journal of Clinical & Medical Oncology, “Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Malignant Peritoneal Mesothelioma.” Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3771391/. Accessed on February 15, 2018.
  3. Indian Journal of Surgical Oncology, “Complications of Cytoreductive Surgery and HIPEC.” Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4818615. Accessed on February 15, 2018.
  4. Journal of Clinical Oncology, “Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Malignant Peritoneal Mesothelioma: Multi-Institutional Experience.” Retrieved from: http://ascopubs.org/doi/full/10.1200/jco.2009.23.9640. Accessed on February 15, 2018.

Last modified: March 30, 2018