Cytoreduction with HIPEC

Cytoreduction 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. To date, Dr. Sugarbaker has performed the procedure more than 1,500 times and is credited with improving patient life expectancy by 50%. Many specialists today call the method the 'Sugarbaker Technique.

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Cytoreduction with HIPEC Overview

Peritoneal mesothelioma patients have the best prognosis of all mesothelioma diagnoses. If you’ve been diagnosed with peritoneal mesothelioma, your specialist may have recommended cytoreduction with HIPEC.

Here’s what you need to know about the potentially curative peritoneal mesothelioma surgery:

  • Dr. Paul Sugarbaker is a pioneer in the field of cytoreductive surgery after developing the ‘Sugarbaker Technique’ in the 1980s.
  • Cytoreduction with HIPEC is considered the most effective treatment for peritoneal mesothelioma, and can only be performed on patients with early-stage tumors.
  • The procedure involves opening up the abdomen, removing visible tumors and bathing the organs in a heated chemotherapy solution.
  • Patients who have undergone the HIPEC procedure after the initial cytoreduction tend to benefit from a 50% increase in survival time.

Cytoreduction with HIPEC Procedure

Peritoneal mesothelioma is caused by ingesting asbestos fibers and is considered a terminal disease. Over the last 30 years, specialists have radically changed their approach to treating peritoneal mesothelioma patients using cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Today, this approach is a standard procedure in peritoneal mesothelioma treatment plans.

The procedure is complicated and lengthy—generally lasting between 10-12 hours to allow the surgeon ample time to examine each organ and lining within the abdominal cavity. Patients will usually be invited into the hospital a day before the surgery to complete preoperative tests, such as cardiac tests, blood tests and x-rays to ensure the patient is well enough to undergo anesthetic for such an extended period.

The surgery takes place in two parts:

1. Cytoreduction

The operation removes the maximum amount of visible tumors through a series of peritonectomy procedures—surgical procedures that remove the peritoneum (abdominal lining).

Patients are given an IV and anesthesia before the surgeon makes a large incision down the center of the abdomen. The organs and abdominal lining are examined, and all visible traces of cancer are removed. This process takes up the vast majority of the full surgery time as it can be incredibly difficult to find the tumors in the peritoneal lining. In extreme cases, non-essential organs such as the appendix and gallbladder are removed to eliminate the spread of cancerous cells.

2. Hyperthermic Intraperitoneal Chemotherapy (HIPEC):

Once the CRS is complete, the surgeon will then flush the abdominal cavity with a warm chemotherapy agent. Temperature probes are placed into the cavity. The abdomen is then semi-closed and flushed with a saline solution. The chemotherapy solution is heated to around 108 degrees Fahrenheit before it gets added to the saline. While the chemicals penetrate the cells, the surgeon massages the abdomen to ensure full and even coverage.

HIPEC allows for a high concentration of chemotherapy in the peritoneal cavity, letting the cells absorb the substance. The heat improves the therapeutic effect by increasing the penetration of the tissue.

Once the chemotherapy solution has been drained, the abdomen is rinsed with saline one last time before the patient is re-opened and the probes removed. Once the surgeon is satisfied, the abdomen is closed entirely, and the patient’s vitals are reviewed. The entire HIPEC process takes between 60-90 minutes, depending on the patient.

The reason that the chemotherapy works so successfully when applied directly to the area is that it does not have to travel through the bloodstream. This means that the surgeon can administer a higher dose to ensure a maximum effect on the tumors and minimum side effects on the patient.

The most serious complication associated with cytoreduction with HIPEC is anastomotic leaks, abdominal bleeds and sepsis. A study published in 2007 gave an operative mortality rate of 12%. Specialists report an impressive 5-year overall survival rate of 70%, which surpasses the results recorded before the heated chemotherapy solution was introduced in conjunction with cytoreduction.

Cytoreduction with HIPEC Benefits

Thanks to the success of cytoreduction with HIPEC, the method is now also used to treat patients with ovarian or gastrointestinal cancer. The operation has been gaining favor over the past two decades as rates of survival show vast improvement.

When HIPEC was first introduced, many specialists did not believe that the results would outweigh the potential risks. The radical procedure was encouraged by renowned oncologist Dr. Paul Sugarbaker, who firmly believes in the science behind the operation.

Dr. Paul Sugarbaker is the Chief of the Peritoneal Surface Malignancy Program and the Director of the Center for Gastrointestinal Malignancies at the Washington Cancer Institute in Washington, DC. He has dedicated his career to investigating a treatment for peritoneal mesothelioma. He believes that this rare form of cancer will be cured in the future, and is credited to lengthen the lives of many patients.

Who is Eligible for Cytoreduction with HIPEC?

Cytoreduction with HIPEC is widely considered to be the most effective treatment for peritoneal mesothelioma. However, not all those who are diagnosed with it are eligible for this treatment. The complex procedure means that a patient must be in good overall health to survive the 10-12 hour surgery and postoperative chemotherapy. Cytoreduction with HIPEC is also only available for those with early-stage mesothelioma, so if the tumors have reached vital organs, then a patient may not be eligible.

Cytoreduction with HIPEC Side Effects and Recovery

Any surgery that can last up to twelve hours is not without its risks, and the postoperative recovery can be just as taxing as the operation itself. Common complications include internal bleeding, cardiac failure, blood clots, mortality, and infection. The digestive system and pulmonary function are also at risk, with 22% of patients reporting some form of surgery-related illness.

With the reputed success of the Cytoreduction with HIPEC procedure, Dr. Sugarbaker has added a further step to his ‘Sugarbaker Technique’. He believes that adding long-term chemotherapy into the recovery process can dramatically extend the life expectancy of his patients. In a 2017 article in the European Journal of Surgical Oncology, Sugarbaker noted that long-term regional chemotherapy (in conjunction with the Cytoreduction with HIPEC procedure) allowed 75% of his patients to reach a 5-year survival.

After surgery, the hospital will keep the patient in their care for one to two weeks. During this time, they will usually complete a round of chemotherapy as curative care, and check vital functions daily.

Once discharged, the patient should expect to recuperate for another two to three weeks at home with moderate activity. There is much strain on the digestive system at this time, so it’s important to rest and eat a nutritionally balanced diet. Some patients may rely on IV’s at home for nutritional supplements.

According to research, the quality of a patient’s life will return to baseline at four months post-surgery but will improve significantly once the patient hits eight to twelve months. A study from 1996 to 2009 reported an overall mortality rate of 3%, which in the treatment of mesothelioma is considered acceptable.

If you’ve been diagnosed with peritoneal mesothelioma and are undergoing cytoreduction with HIPEC, then contact our Victims Advocates today for more information on seeking legal compensation for your treatment costs.

Mesothelioma Support Team
Stephanie KiddWritten by:


Stephanie Kidd works tirelessly as a dedicated advocate for the vulnerable and underrepresented. Stephanie worked as a copywriter for an agency whose focus was communicating safety procedures on construction work sites. With her extensive background in victim advocacy and a dedication to seeing justice done, Stephanie works hard to ensure that all online content is reliable, truthful and helpful.

View 7 Sources
  1. Hindawi: Quality of Life Study following Cytoreductive Surgery and Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei including Redo Procedures
    Retrieved via:
    Accessed February 10, 2018.
  2. NHS England: Clinical Commissioning Policy: Cytoreduction surgery for patients with peritoneal carcinomastosis.
    Retrieved via:
    Accessed February 10, 2018.
  3. NCBI: Patient selection for cytoreductive surgery and HIPEC for the treatment of peritoneal metastases from colorectal cancer.
    Retrieved via:
    Accessed February 10, 2018.
  4. Science Direct: European Journal of Surgical Oncology (EJSO), Volume 43. Issue 7. July 2017 - P.H. Sugarbaker, D. Chang.
    Retrieved via:
    Accessed February 10, 2018.
  5. Sugarbaker Oncology.
    Retrieved via:
    Accessed February 10, 2018.
  6. Mayo Clinic: Cytoreductive surgery and HIPEC offers effective treatment for selected patients with peritoneal carcinomatosis
    Retrieved via:
    Accessed February 10, 2018.
  7. Johns Hopskins: Cytoreductive Surgery and Heated Chemotherapy (HIPEC)
    Retrieved via:
    Accessed February 10, 2018.
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