What is HIPEC?
Hyperthermia Intraperitoneal chemotherapy (HIPEC), i.e. hot chemotherapy, is a proven method especially in the advanced stage of cancer in the abdominal area such as stomach, appendicitis, ovary and colon. It is a procedure in the treatment of abdominal tumours, including the excision of visible tumours or cancer in the abdomen by cytoreductive surgery and administering chemotherapy drugs to the affected region.
The combination of heat and chemotherapy in HIPAC, which is usually introduced in the second stage of intraabdominal cancer treatment – the first is cytoreductive surgery as mentioned above-, has been shown to be more effective than the traditional chemotherapy treatment for some patients. Because this treatment destroys much more of the cancer cell that can be seen with the naked eye.
HIPEC which has been in use for more than twenty years worldwide, is now regarded as safe besides being a complex and severe operation. The complication rate has gradually decreased in the last decade. It has been observed that the risk of complications ending with death is less than 3% in the experienced HIPEC centres. This is more acceptable than other high-risk surgical procedures but there are various side effects and risks of HIPEC.
Since HIPEC is usually performed after cytoreductive surgery, which is a severe surgery, complications occur in about 30% of patients afterwards. Complications such as bleeding or infection that can be seen after any surgery may also occur after this procedure.
Most of the common side effects of HIPEC are not different from the traditional chemotherapy treatment and many studies show that severe side effects are even less in this treatment.
Side effects and risks of HIPEC may include:
- After HIPEC, lung or bladder inflammation, injuries and nutritional disorders can be seen.
- Risk of leaking of intestinal adherence joints (anastomosis) – The risk of abdominal inflammation by the infiltration of intestinal materials into the abdomen is low but among serious complications. In such a case, another operation may be required to prevent leakage.
- Pancreas inflammation (pancreatitis) – About 6-7 out of every 100 patients develop this problem, which is rare.
- Post-operative bleeding and intestinal leaks through tissues might occur. It is again a rare complication which is seen about 4 to 5 out of 100 patients.
- The decreasing number of white cells in the blood and therefore the risk of inflammation or bleeding is seen 1 out of 10 patients.
- Nausea and vomiting –The severity of this condition varies from person to person and when necessary nausea prevention drugs are given to the patient. The tube that is placed thorough your nose into the stomach after surgery helps prevent nausea and vomiting, albeit annoying at the same time.
- Susceptibility to infections – After hyperthermic intraperitoneal chemotherapy (HIPEC), the susceptibility to infection (abdominal inflammation – peritonitis) increases. However, there is already a risk of infection only with chemotherapy.
- Prolongation of the recovery period – After HIPEC treatment with cytoreductive surgery, the recovery process may be slightly prolonged.
- Lethargy / fatigue – Traditional chemotherapy makes the patient feel tired on its own. After such a major operation, usually performed in two stages, patients might feel more tired and need more resting which is quite possible. It may take some time for the patient to regain normal energy level after the operation. After about three months, life quality returns to the pre-operative level.
- Decrease in appetite
- Diarrhoea – This problem is also seen occasionally. However, diarrhoea arises from the surgery rather than chemotherapy.
- Mouth sore – Although with low possibility following the treatment, wounds might occur in the mouth. In this case, you should consult your doctor because you may need a gargle.
- After HIPEC, intense hair loss is also rarely seen.
As in the traditional chemotherapy, it is normal that patients feel constantly depressive and unhappy after HIPEC as well. Patients can overcome this process more easily by having correct information and realistic expectations and with the support of family members and the healthcare team.