HIPEC is a difficult operation that lasts 7-10 hours. Every patient cannot stand such a long surgery. It is important to ensure that the patient meets the minimum medical proficiency level determined by the medical oncologist or other specialists. In other words, the first and foremost feature of these patients who are candidates for this treatment is whether their general health conditions are good or not except cancer diagnosis. Surgery is usually very risky for patients who have a heart disease or other chronic diseases.
In HIPEC, patients who will benefit from the surgery are chosen only. HIPEC can no longer be an effective treatment option if the degree of tumour growth is progressed excessively or cancer has spread out of the abdomen. Therefore, in cases where tumour growth is not possible, cytoreductive surgery is first performed to remove the primary tumour and tumours spread along the abdomen. Clinical studies have shown that much more effective results are achieved in patients where tumours are excised entirely or partially before HIPEC operation.
The following factors are taken into consideration when determining to which patients HIPEC can be applied:
General health condition – As mentioned above, HIPEC is a long-lasting and invasive procedure, especially when combined with cytoreductive surgery. For this reason, it is first determined whether the general condition of the patient is good and whether there is a serious problem that can prevent large-scale major operations to be performed under general anaesthesia. Except for cancer, it is useful to consult the opinions of other specialists of the patient before taking the decision of surgery if there are one or more of the diseases which are highly risky for surgery such as a heart disease, blood pressure, diabetes.
Transabdominal extension –Cancer can spread from the four main routes in your abdomen:
- Blood flow
- Local growth or spreading through the region by a direct contact
- Lymph nodes
- Transabdominal extension or extension along the abdomen
HIPEC is the most convenient treatment option for patients with transabdominal extension when carcinomatosis shows relatively restricted extension in tumour size and spread. Some abdominal cancers adhere to a major organ surface rather than internal organs. When these cancer cells break out, they can spew out cancer almost like a spray, and these cells can be held in many parts of the abdomen. It is very difficult to excise such extended cancer by surgery alone.
It should be ensured that HIPEC can help the patient. If the cancer of the patient has spread outside the abdominal cavity, this treatment is no longer appropriate. For example, in some abdominal cancers such as pancreatic cancer that has spread outside the pancreas, this treatment is not preferable. Since it works with the circulation of chemotherapy drug in the abdominal cavity, HIPEC is a good option to treat cancer limited only to this region.
Age Factor – In the past, it was thought that elderly patients could not get good results with surgeries such as HIPAC. However, this view has changed since high-positive surgical outcomes have been achieved among elderly patients who have received HIPAC worldwide in the last 10 years. Similar low complications and high survival rates were obtained when patients between the ages of 60 and 65-80 years were compared.
Type of cancer –In HIPAC, cases of carcinomatosis arising from a cancer that is not very aggressive are chosen. Carcinomatosis resulting from stomach cancer is so aggressive that this technique functions very limited and is only used in very special cases and as a part of research studies. In addition to this, HIPAC can be used in the treatment of appendicitis cancer, colon cancer, specific forms of ovarian cancer or in the treatment of tumours of the peritoneum (peritoneal mesothelioma or primary peritoneal carcinoma). In some cases, the treatment provides maximum results when completed with intravenous chemotherapy.