HIPEC

Heated Intraperitoneal Chemotherapy is a novel procedure in the management of peritoneal carcinomatosis including ovarian cancers.

In this procedure, chemotherapeutic agents are heated to a temperature of 41-43 degree Celcius and then uniformaly distributed in the abdominal cavity for 90 minutes after the cytoreductive surgery for ovarian cancer is done.

Combined surgery and chemotherapy by this route is an extensive procedure and referred to as MOAS( Mother of All Surgeries).

• Term HIPEC coined by the group from the Netherlands Cancer Institute and is used world over in the management of peritoneal carcinomas.
• Hyperthermia
  It self exhibits a selective cell-killing effect to malignant cells potentiates the cytotoxic effect of chemotherapy agents, enhances the tissue penetration of the administered drug.
• The intraperitoneal route, when properly used, will allow uniform distribution by surgeon/ positional changes high concentration of anticancer therapy at the site of the malignancy When disease load is minimal
• Peritonectomy procedures should aim address macroscopic disease.
• Isolated tumor nodules are removed using electroevaporation (viable tumor cells at margin)
• Electroevaporation/ electrosurgery

Less blood loss, less dissemination of tumor cells. High energy likely to kill tumor cells at resection margin

Closed method for the delivery of HIPEC. An inflow line, an outflow line, and two temperature probes emerge through the temporarily closed midline laparotomy wound.

There have been various trials showing the benefecial effects of HIPEC in various settings in the management of ovarian cancer and an individualised decision needs to be taken on a case-by-case analysis for the indication of CRS and HIPEC in a particular case.