What does HIPEC consist of?
Hyperthermicintraperitoneal chemotherapy consists of the use of medicines with antitumoral effects (chemotherapy) in the peritoneal cavity, increasing its effect with heat (hyperthermia). Combined with the surgical cytoreduction, this procedure is the basis for treating PERITONEAL CARCINOMATOSIS.
This is one of the intraabdominal dissemination forms of gastrointestinal and gynecologic malignant tumors, as well as abdominopelvic sarcomas, regardless of the evidence of distant metastasis.
Traditionally, peritoneal carcinomatosis was considered an incurable late stage that could only be treated with systemic chemotherapy or palliative surgery. However, studies performed in the 1980s by Sugarbaker suggested that peritoneal carcinomatosis must be considered as a locoregionalneoplastic manifestation.
THERAPEUTICAL APPROACH TO PERITONEAL CARCINOMATOSIS
It is based on 3 cornerstones:
CORRECT SELECTION OF PATIENTS:
For the correct selection of patients, it is essential that an adequate medical record and preoperative staging is provided, which may include laparoscopy in order to determine the peritoneal extension and to discard distant affection.
A successful result depends mainly on the surgeon's ability to complete the cytoreductor process, so that there is no visible tumoral remain. This radical surgery is possible thanks to a surgical strategy called perinectomy, which eliminates the peritoneal serum and nearby affected structures, but preserves the healthy peritoneum as a protective element against the tumoral dissemination.
QHYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY:
the reason for this therapy is treating the microscopic residual disease (“what the eye doesn’t see”), which is responsible for the recurrence. The intraperitoneal approach permits using higher doses of chemotherapic treatments, whereas the hyperthermia increases their effects.
Thanks to this treatment, the unwanted systemic secondary effects are also reduced (nausea, vomits) and the direct action of the treatment is strengthened as well.
The "Coliseum technique" is used when this therapeutical modality is applied. The abdomen is left open and the viscera are submerged in a solution that contains the chemotherapy drugs. The temperature must remain constant, about 42-43 Celsius degree in order to avoid injuring the organs.
The incoming and exiting flows, the intrabdominal temperature and the exposition time are controlled automatically through sophisticated software installed in the PERFORMER LRT RAND machine.
INDICATIONS FOR THE HIPEC
- Epithelial ovarian carcinoma (stage III/IV)
- Colorectal cancer.
- Gastric cancer.
- Diffuse mesothelioma of the peritoneum.
- Pseudomyxoma peritonei.
- Peritoneal sarcomatosis.
The multidisciplinary treatment offers significantly higher survival rates than conventional treatments; however, morbidity and mortality are also higher. This is why it is necessary to perform a correct selection of the candidates who can benefit from the treatment. The general condition of the patient must be acceptable; there cannot be any extra-abdominal metastatic disease and the carcinomatosis index cannot be very high either..