Cytoreductive Surgery With HIPEC

Cytoreductive surgery is the only surgery known to effectively treat peritoneal mesothelioma. It involves an invasive procedure to remove abdominal tumors. World-renowned oncologist Dr. Paul Sugarbaker developed an idea to combine cytoreduction with hyperthermic intraperitoneal chemotherapy (HIPEC) to decrease the mortality rate in his patients.

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Fact-Checked and Medically Edited by: Dr. Assuntina Sacco, Board-Certified Oncologist

What Is Cytoreductive Surgery With HIPEC?

Doctors often recommend a mesothelioma surgery called cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) to their peritoneal mesothelioma patients.

Peritoneal mesothelioma is a type of cancer that is found in the lining of the abdomen (the peritoneum) and is caused by ingesting asbestos fibers, accounting for around 20-25% of all mesothelioma cases.

Cytoreductive surgery with HIPEC is the only curative (meant to extend a patient’s life) surgical option available to patients with peritoneal mesothelioma.

Cytoreductive surgery (CRS) with HIPEC is a two-part procedure:

  • The first part involves invasive surgery to remove visible tumors from the abdomen through a process called debulking.
  • The second part of the procedure involves hyperthermic intraperitoneal chemotherapy (HIPEC), which is a process that flushes the abdominal cavity with a warm chemotherapy agent.

HIPEC cytoreductive surgery was developed in the 1980s by oncologist (cancer doctor) Dr. Paul Sugarbaker. He has seen success in using this two-part procedure over 1,500 times.

Cytoreductive Surgery with HIPEC and Life Expectancies
Cytoreductive surgery with HIPEC has been shown to improve a patient’s life expectancy by 50%.

Today, many mesothelioma doctors refer to the method of using cytoreductive surgery with HIPEC as the ‘Sugarbaker Technique’.

Quick Facts About Cytoreductive Surgery With HIPEC

  • Dr. Sugarbaker, the pioneer of cytoreductive surgery with HIPEC, has successfully performed the procedure over 1,500 times.
  • Intraoperative chemotherapy avoids many side effects typically caused by regular chemotherapy such as nausea and hair loss.
  • This procedure is considered the most effective form of treatment for peritoneal mesothelioma, with a clear trend towards survival for those suffering from the disease.
  • Currently, cytoreductive surgery with HIPEC is the only effective treatment for peritoneal mesothelioma.

Cytoreductive Surgery With HIPEC Procedure

Cytoreductive surgery with HIPEC is a complex process that is made up of two surgical procedures performed by a mesothelioma doctor who specializes in surgical oncology. The full procedure typically takes 10-12 hours.

Patients may require intravenous or oral mesothelioma chemotherapy treatments before or after surgery. The process of applying the chemotherapy agent directly to the abdomen reduces the chance of negative side effects associated with chemotherapy that is routinely given intravenously (through a vein).

Currently, cytoreductive surgery with HIPEC is the only effective treatment for peritoneal mesothelioma.

Mesothelioma Cytoreductive Surgery

The first phase of the HIPEC cytoreductive surgery involves surgically removing all visible tumors from the abdomen using cytoreductive surgery, otherwise known as tumor debulking.

Did You Know?

This mesothelioma surgery happens through an open incision that extends from the bottom of the sternum to the top of the pubic bone.

The extent of the overall surgery is dependent on the disease stage and the location of the tumors in the affected area.

Before the procedure, surgeons will discuss the possibility of having to remove organs or parts of organs to effectively rid the area of tumors.

Mesothelioma Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

When the cytoreduction surgery is complete and all visible mesothelioma tumors have been removed, part two of the procedure, hyperthermic intraperitoneal chemotherapy or HIPEC, will begin.

The HIPEC procedure involves the following steps:

  1. Doctors add a saline solution to the abdominal area through the closed or partially closed incision.
  2. The abdomen is flushed out with the solution.
  3. A chemotherapy agent is heated to 108 degrees Fahrenheit and added to the saline already flushing the area.
  4. The surgeon massages the abdomen to ensure that even coverage of the heated chemotherapy is achieved.

Doctors use a heated mesothelioma chemotherapy agent to improve the effect of the drugs, allowing for better penetration in the cancer cells.

Did You Know?

The main focus of HIPEC is to rid the affected area of any remaining mesothelioma cancer cells to minimize the chances of having new tumors grow from these individual cells that are not visible to the naked eye.

This heated chemotherapy treatment is believed to be more successful in treating peritoneal mesothelioma than a highly concentrated dose of intravenous chemotherapy.

Using this process also prevents chemotherapy from reaching the bloodstream, which minimizes the side effects typically associated with intravenous chemotherapy treatments.

HIPEC Treatment Times
This process takes approximately 60-90 minutes to complete but can vary depending on the patient.

Specialists have seen an increase of approximately 70% in survival rates using this technique in conjunction with cytoreduction, which far surpasses surgery and standard chemotherapy being used as standalone treatments.

Patients interested in this surgery should contact a doctor after a diagnosis has been confirmed. They can also learn how to afford treatments by speaking with a mesothelioma lawyer.

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Benefits of HIPEC Cytoreductive Surgery

Medical data analyzed by the Annals of Translational Medicine shows that cytoreductive surgery and HIPEC treatment has increased overall survival rates in peritoneal mesothelioma patients by 50%.

This success had led to medical professionals using the procedure to treat other forms of gastrointestinal cancer along with ovarian cancer.

Did You Know?

The benefits of HIPEC cytoreductive surgery can be seen in a clear trend towards survival amongst patients with peritoneal cancer, along with a well-tolerated side effect profile.

Due to the nature of the concentrated one-time dose of chemotherapy drugs, patients get the benefits of chemotherapy without adverse side effects such as nausea, vomiting, and hair loss.

HIPEC Cytoreductive Surgery Risks and Side Effects

Due to the invasiveness and long potential duration of this surgery, complications in the process are relevant factors in the success and recovery of patients during and after cytoreductive surgery and HIPEC treatment.

Although only a small fraction of patients (22%) report some form of surgery-related illness, it is important to be aware of potential complications associated with the procedure.

Complications may include:

  • Blood clots
  • Heart failure
  • Digestive problems
  • Infection
  • Internal bleeding
  • Death

Side effects of cytoreductive surgery and HIPEC include:

  • Bleeding and bruising easily
  • Blood pressure/heart rate change
  • Constipation
  • Diarrhea
  • Feeling sick and tired
  • Hair loss
  • Loss of appetite and weight
  • Lower resistance to infections

The most common side effects from the high-temperature dose of chemotherapy within the HIPEC procedure are the slowing of bowels and increases in white blood cell and platelet counts.

Even though these side effects can be serious in nature, they tend to return to normal levels within hours of the procedure.

Handling Cytoreduction and HIPEC Side Effects

The side effects of cytoreduction with HIPEC can be uncomfortable, even when not as extreme as the effects of systemic chemotherapy (chemotherapy injected into a vein or given orally).

Learn about common side effects and how to manage them below.

  • Fatigue

    Overall, following the surgery, patients can expect to feel fatigued because their body is recovering from this complex surgery. Patients will gradually improve based on levels of daily activity and needed rest.

  • Nausea and Pain

    Nausea and pain are also relevant side effects of the procedure, but these can be managed through the use of prescribed medications.

  • Hair loss

    Hair loss is another common side effect of the procedure, but it is temporary and can be managed with time and good nutritional habits.

  • Loss of Appetite

    One of the most common side effects is the loss of appetite, which can be managed through eating small, more frequent meals.

Like any major surgery, there are side effects associated with the process such as risks of bleeding, infection, and poor reactions to general anesthesia.

These side effects are often minor but are managed in the hospital on a case by case basis.

Who Is Eligible for Cytoreduction with HIPEC?

Even though cytoreduction surgery with HIPEC is the leading treatment for peritoneal mesothelioma, not everyone is eligible.

There are factors that must be taken into consideration before someone is selected to participate in the treatment.

Surgery Times and Patient Health
The main eligibility factor considered is the patient’s baseline health. Due to the surgery’s duration, which can last 10-12 hours, the patient must be in overall good health.

Another factor that must be considered is the patient’s peritoneal mesothelioma stage. Only patients with early-stage peritoneal mesothelioma will be considered eligible for the treatment.

This is confirmed by seeing if the cancer has reached vital organs, which can have a significant impact on the success of HIPEC cytoreductive surgery and the ability of the patient to recover.

HIPEC Cytoreductive Surgery Recovery

Patients recovering from cytoreduction surgery with HIPEC can expect to spend an average of 2-3 months recovering from the treatment.

HIPEC Cytoreductive Hospital Stay Recovery

The first part of recovery is a short hospital stay at a mesothelioma cancer center or another treatment facility.

Did You Know?

Patients should expect to stay in the hospital for approximately 10-14 days. Most patients are released from the hospital around day 8 or 9.

During their stay at the hospital, patients will most likely complete one round of chemotherapy while having their vitals monitored on a daily basis.

The next stage of recovery for patients is discharge from the hospital where they will return home and continue the recovery process.

HIPEC Cytoreductive Recovery at Home

Patients will continue to recuperate at home with moderate activity and lots of rest for at least the next 2-3 weeks.

Due to the area of the surgery in the patient’s body, there is a considerable strain on the digestive system and in some cases, patients will require an IV in order to get the required nutrients for a successful recovery.

Surgery Recovery Times
Research has shown that patients should feel relatively back to normal after roughly 4 months. The same research shows that a patient’s quality of life is significantly increased in the 8-12-month range.

To best aid in recovery, patients should:

  • Stay active: Walking and doing non-strenuous activities around the house are often good ways to stay active. Getting up and walking will open your lungs and get the blood flowing from your legs to your heart, which will aid in avoiding post-surgery infections and complications.
  • Maintain good nutrition: Good nutrition aids in the body’s natural healing and plays a major role in recovery post-procedure. Doctors should discuss a nutritional regimen with patients following HIPEC cytoreductive surgery.

Patients can get advice about recovering from home by talking to their doctors.

Learn More about Cytoreductive Surgery With HIPEC

You may have a lot of questions if you or someone you love has been diagnosed with peritoneal mesothelioma.

If you would like to learn more about peritoneal mesothelioma treatment options and get more information during this trying time, please reach out to our dedicated mesothelioma support team.

We are standing by to help you today. Download our free mesothelioma guide today.

Mesothelioma Support Team
Reviewed by:Dr. Assuntina Sacco

Board-Certified Oncologist

  • Fact-Checked
  • Editor

Assuntina Sacco, MD is an Associate Professor of Internal Medicine at the University of California, San Diego (UCSD) Moores Cancer Center, where she also serves as the Medical Director of Infusion Services. She is a board-certified medical oncologist trained to treat all solid tumor types, with the use of chemotherapy, immunotherapy, targeted therapy, and clinical trials.

Dr. Assuntina Sacco is an independently paid medical reviewer.

Stephanie KiddWritten by:

Editor-in-Chief

Stephanie Kidd grew up in a family of civil servants, blue-collar workers, and medical caregivers. Upon graduating Summa Cum Laude from Stetson University, she began her career specializing in worker safety regulations and communications. Now, a proud member of the American Medical Writers Association (AMWA) and Editor-in-Chief of the Mesothelioma Cancer Network, Stephanie serves as a voice for mesothelioma victims and their families.

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