How Is HIPEC Performed? Tumor Removal Followed by Heated Chemotherapy Inside the Abdomen

The scan report uses a phrase most people have never heard: peritoneal carcinomatosis. A surgeon draws a rough oval on a notepad, shades in a few dots along its edge, and says the word HIPEC. Somewhere between the drawing and the drive home, the question forms. What would actually be done to me?

Understanding how HIPEC is performed helps because the name hides two very different events. The first is a long, painstaking operation to remove visible cancer from the lining of the abdomen. The second lasts well under two hours and involves warm chemotherapy washing across the raw surfaces that remain. One is about hands and scalpels; the other is about temperature and timing.

This explainer walks through both, in order, along with who tends to be offered the procedure, why oncologists still argue about it, and what the weeks afterward usually look like. Every treatment decision stays with your surgical and oncology team; the aim here is to make their conversation easier to follow.

How HIPEC is performed: what actually happens in the operating room

HIPEC stands for hyperthermic intraperitoneal chemotherapy, which in plain language means heated chemotherapy delivered directly into the abdominal cavity. It is almost always paired with cytoreductive surgery, the operation that removes visible tumor first. Together the pair is usually written CRS-HIPEC.

The day begins like any major abdominal surgery. After general anesthesia, the surgeon opens the abdomen with a long vertical incision so that every surface can be inspected. The peritoneum, the thin membrane that lines the abdominal wall and wraps the organs, is examined inch by inch. Each tumor deposit is scored by location and size, producing a total known as the peritoneal cancer index.

Removal comes next and takes up most of the day. Tumor-covered peritoneum is stripped away in sheets. Organs that cannot be cleared may be partly or fully removed, commonly the omentum (the fatty apron over the intestines), the spleen, the gallbladder, sections of bowel, or in women the ovaries and uterus. According to Johns Hopkins Medicine, the full operation can run 8–14 hours depending on how much disease is present.

Only when the surgeon is satisfied that no visible tumor remains, or that nothing larger than a few millimeters is left, does the chemotherapy phase begin. Tubes are placed through the abdominal wall and connected to a perfusion machine, a pump-and-heater circuit that warms the drug solution and pushes it through the cavity. Temperature probes are placed inside the abdomen so the team can hold the fluid within its target range. Once the timed wash is complete, the fluid is drained, the abdomen is rinsed, any bowel reconnections are completed, and the incision is closed.

What is cytoreductive surgery, and why does it come first?

Cytoreductive surgery means reducing the number of cancer cells by physically cutting out tumor. In the peritoneal setting the goal is stricter than in most cancer operations: surgeons aim to leave nothing they can see. This is graded with a completeness of cytoreduction score, where CC-0 means no visible disease remains and CC-1 means only deposits smaller than about 2.5 millimeters are left, per the scoring system described in the peritoneal surgery literature summarized by Cleveland Clinic.

The order matters because of how chemotherapy travels through tissue. Drugs poured into the abdomen soak into surfaces only a few cell layers deep, on the order of 1–3 millimeters according to Johns Hopkins Medicine. A tumor nodule the size of a grape would be bathed on the outside and untouched at its center. Surgery removes the bulk; the heated wash is designed for the microscopic residue that even a careful eye cannot detect.

This is also why the operation is so long. Peritonectomy, the stripping of the lining from the diaphragm, pelvis, and abdominal wall, is slow and deliberate. Removing a coated omentum or a length of bowel adds hours. Surgeons often describe the work as more like clearing a field than removing a single object.

The extent of cytoreduction shapes almost everything that follows: how long recovery takes, whether an ostomy (a surgical opening for stool to leave the body) is needed, and how likely the team is to proceed with the heated chemotherapy at all. If disease proves too widespread to clear during the operation, the surgical team may decide not to perform HIPEC, since the evidence for its benefit rests on completing the removal first.

How does heating chemotherapy change the way it works?

Heat does three useful things when combined with certain chemotherapy drugs, and none of them is mysterious. First, warmth at roughly 41–43°C damages cancer cells more readily than normal cells, which tolerate the range better. Second, heat increases how deeply some drugs penetrate tissue, though still only by a few millimeters. Third, heat interferes with the repair machinery cells use to fix chemotherapy-induced DNA damage, so the same exposure does more harm to malignant cells. Cleveland Clinic and Johns Hopkins Medicine describe these mechanisms in their patient explanations of the procedure.

The intraperitoneal route adds a separate advantage. When chemotherapy is given through a vein, the drug must circulate through the whole body, and the peritoneal surfaces receive only a modest share. Poured directly into the cavity, the same agent can reach the lining at concentrations many times higher than would be tolerable through the bloodstream, because a barrier called the peritoneal-plasma barrier slows its absorption into the general circulation. Some of the drug does cross into the blood, which is why patients are monitored for systemic effects afterward.

Drug choice depends on the cancer type and the surgeon’s protocol. Mitomycin and oxaliplatin are the agents most often described for gastrointestinal cancers, while cisplatin is common in ovarian protocols. These names appear here only to explain the trial results discussed later; the selection, quantity, and timing are entirely the province of the treating team and are individualized.

Temperature, duration, and drug together define the wash. Most published protocols hold the fluid in the abdomen for 30–90 minutes, with 90 minutes the most frequently quoted figure in Cleveland Clinic and Johns Hopkins patient materials. The machine gently agitates or the surgeon manually distributes the fluid so that every fold of bowel and every recess of the pelvis is bathed.

How is HIPEC performed with open versus closed techniques, and how long does it take?

Two broad methods exist for the chemotherapy phase, and the difference is mostly about the abdominal wall. In the open technique, sometimes called the coliseum method, the edges of the incision are suspended from a frame so the abdomen forms an open basin. The surgeon stands at the table and stirs the heated fluid by hand, making sure it reaches under the liver, behind the stomach, and deep into the pelvis. A plastic sheet covers the opening to limit vapor, and staff wear protective gear.

In the closed technique, the incision is temporarily sutured shut around the inflow and outflow tubes. The perfusion machine then circulates fluid through the sealed cavity, and the team may rock the operating table or press on the abdomen to encourage even distribution. The closed approach reduces heat loss and staff exposure; the open approach gives the surgeon direct control over where the fluid goes. Neither has been shown to be clearly superior in outcomes, and surgeons generally use the method they were trained in.

Timing across the whole day breaks down roughly like this, using ranges from Johns Hopkins Medicine and Cleveland Clinic:

• Cytoreductive surgery: typically several hours, and often the majority of an 8–14 hour operation.
• Heated perfusion: about 30–90 minutes at target temperature.
• Drainage, rinsing, bowel reconnection, and closure: additional time that varies with the extent of resection.

Because the operation is long, patients are typically moved to an intensive care unit or a high-dependency ward afterward, not because something has gone wrong but because fluid balance, kidney function, and blood counts need close watching in the first 24–72 hours. Families are usually warned in advance that the day will be lengthy and that updates may be infrequent while the team is working.

Who is HIPEC usually for, and who is usually asked to wait?

HIPEC is offered when cancer has spread across the peritoneal lining but appears to have gone nowhere else. The condition is called peritoneal carcinomatosis, or peritoneal metastasis, and it can arise from several primary sites. Cancers most often considered include appendix cancer and its mucus-producing variant pseudomyxoma peritonei, colorectal cancer with limited peritoneal spread, mesothelioma of the peritoneum, selected ovarian cancers, and occasionally gastric cancer within research settings.

Suitability is assessed carefully, because the operation demands a great deal from the body. Teams usually look at:

• Imaging, typically CT and sometimes MRI or PET, to rule out liver, lung, or bone spread.
• An estimate of the peritoneal cancer index, since very extensive disease is harder to clear completely.
• Overall fitness, including heart, lung, and kidney function, and nutritional status.
• Whether the cancer type is one for which the evidence supports the approach.

Some patients are asked to wait or are steered elsewhere. If scans show disease outside the abdomen, HIPEC is generally not pursued, because the treatment only reaches the cavity. If the volume of peritoneal disease looks too large to remove, systemic chemotherapy may be given first, with reassessment later. Frailty, significant heart or lung disease, or poor kidney function can also tip the balance, since the operation itself carries real risk. A diagnostic laparoscopy, a small-camera look inside the abdomen, is sometimes used to settle the question before committing to a full opening.

None of these judgments is made by one person. Most centers that offer the procedure run a multidisciplinary tumor board where surgeons, medical oncologists, radiologists, and pathologists weigh the case together. Asking how that discussion went, and what factors weighed most, is a reasonable request.

Which cancers have the strongest evidence for HIPEC?

Evidence strength varies sharply by cancer type, and honest counseling reflects that. The table below summarizes the general picture drawn from the trials and reviews discussed in this article; it is a guide to the conversation, not a verdict on any individual case.

Cancer type	What the evidence base mainly consists of	General status
Appendix cancer and pseudomyxoma peritonei	Large observational series; no randomized trials, since the disease is rare	Widely accepted standard when complete removal is possible
Colorectal peritoneal metastasis	One early randomized trial of CRS-HIPEC versus chemotherapy alone; one later trial testing the HIPEC step itself	Surgery supported; added value of the heated wash questioned
Peritoneal mesothelioma	Observational series and registries	Commonly offered in specialized centers
Ovarian cancer	Several randomized trials with differing designs and mixed results	Considered in selected situations; not universal
Gastric cancer	Ongoing trials, mostly outside North America	Largely investigational

Two patterns stand out. The disease for which HIPEC is most established, appendix cancer, has never been tested in a randomized trial, because too few people develop it for such a trial to be practical. The disease that has been tested most rigorously, colorectal cancer, produced results that complicated the story. Both facts are true at once, and both should inform expectations.

For ovarian cancer, the picture depends heavily on timing. The trial that showed a benefit gave HIPEC at interval surgery, meaning after initial chemotherapy had shrunk the disease. Trials at other points in the treatment course have not consistently shown the same effect, which is why gynecologic oncology guidelines describe HIPEC as an option in specific circumstances rather than a routine step.

Why is HIPEC controversial?

The controversy is real, and it comes down to a single design problem. CRS-HIPEC bundles two treatments into one day, and for years it was impossible to tell how much benefit came from the surgery and how much from the heated chemotherapy. When patients did well, the whole package got the credit.

The French PRODIGE 7 trial, published in The Lancet Oncology and indexed on PubMed, set out to separate the two. Patients with colorectal peritoneal metastasis all had complete cytoreductive surgery; half were then randomized to receive oxaliplatin-based HIPEC and half were not. Median overall survival was 41.7 months with HIPEC and 41.2 months without, a difference the investigators judged not statistically significant. Serious complications at 60 days were more frequent in the HIPEC group. The implication was uncomfortable: in this cancer, with this drug and protocol, the heated wash appeared to add risk without clearly adding survival, while the surgery itself seemed to be doing the heavy lifting.

Supporters point out several limits. The trial used one drug at one duration; other agents and longer perfusions were not tested. A subgroup with intermediate disease volume appeared to fare better, though subgroup findings are hypothesis-generating rather than proof. And the results apply to colorectal cancer, not to appendix cancer or mesothelioma, where the biology differs.

Critics respond that observational data, however large, cannot rule out selection bias: the patients chosen for a 10-hour operation are, almost by definition, fitter and have less aggressive disease. Both sides agree on one thing. Complete surgical removal is the part with the strongest support, and HIPEC should be performed by experienced teams within protocols or trials. That shared ground is a useful frame for any patient conversation.

What does the research show about survival after HIPEC surgery?

People searching for a survival rate after HIPEC usually find a jumble of percentages pulled from different cancers, different eras, and different centers. Numbers from one context transfer poorly to another, so this section sticks to figures from named randomized trials and states exactly what each measured.

In colorectal cancer, a Dutch trial published in the Journal of Clinical Oncology in 2003 randomized patients with peritoneal metastasis to systemic chemotherapy alone or to cytoreductive surgery with mitomycin-based HIPEC followed by the same chemotherapy. Median survival was 22.3 months in the surgery-plus-HIPEC arm versus 12.6 months with chemotherapy alone. Systemic chemotherapy has improved considerably since then, and the trial could not separate the surgical effect from the HIPEC effect, which is precisely what PRODIGE 7 later examined with the results described above.

In ovarian cancer, the OVHIPEC-1 trial published in the New England Journal of Medicine randomized women undergoing interval cytoreductive surgery after initial chemotherapy to surgery alone or surgery with cisplatin-based HIPEC. Median overall survival was 45.7 months with HIPEC versus 33.9 months without, and the rate of serious adverse events did not differ meaningfully between groups. The trial has been influential but also debated, partly because of its size and partly because its surgery-alone arm performed less well than some expected.

For appendix cancer and pseudomyxoma peritonei, no randomized trial exists. Long-term outcomes reported by specialized centers are generally favorable when complete removal is achieved, but these are single-institution or registry data and are shaped by patient selection.

What this means for one person is impossible to read off a table. Cancer type, how completely disease was removed, tumor grade, and overall health all change the picture. The oncology team can place an individual’s situation against the relevant data far more accurately than any general article.

HIPEC side effects: what complications are surgeons watching for?

Side effects after CRS-HIPEC come from two directions, and the surgical ones usually dominate. Removing lengths of bowel, stripping the peritoneum, and spending many hours under anesthesia carry the risks of any major abdominal operation, magnified by scale.

The complications teams monitor most closely include:

• Anastomotic leak, where a reconnection between two pieces of bowel fails to heal and intestinal contents escape. This is among the most serious surgical risks and may require a return to the operating room.
• Bleeding, infection of the wound or abdominal cavity, and collections of fluid that may need drainage.
• Prolonged ileus, meaning the bowel is slow to resume normal movement, which delays eating.
• Blood clots in the legs or lungs, a risk raised by long surgery and reduced mobility.
• Fistula, an abnormal channel between bowel and skin or another organ.

The chemotherapy adds its own layer. Some drug is absorbed into the bloodstream, so blood counts can fall in the days after surgery, raising infection risk. Kidney function is watched closely, particularly with platinum-based agents, and the heat and fluid shifts of a long operation strain the kidneys further. Nausea and temporary changes in taste are common. Cleveland Clinic and Johns Hopkins Medicine both note that major complications occur in a meaningful minority of patients and that the risk rises with the extent of surgery.

Mortality within 30 days is low in experienced hands but not zero, and any team offering the procedure should be willing to share its own figures. Longer-term effects depend on what was removed: a shortened bowel can change stool frequency, splenectomy requires certain vaccinations, and an ostomy may be temporary or permanent. Each of these should be discussed before consent, not after.

HIPEC surgery recovery time: the first days, then the following weeks

Recovery begins in the intensive care or step-down unit. For the first day or two the focus is on breathing, fluid balance, kidney function, and pain control, often through an epidural or a patient-controlled pump. A nasogastric tube may drain the stomach until the bowel wakes up, and drains placed at surgery collect fluid from the abdomen.

Hospital stays commonly run 1–2 weeks, and sometimes longer when the operation was extensive or a complication arises, according to Johns Hopkins Medicine and Cleveland Clinic. During that time the milestones are unglamorous but meaningful: sitting in a chair, walking the corridor, passing gas, tolerating sips and then soft food, and having tubes removed one by one. Nutrition can lag; some patients need intravenous or tube feeding for a period while the gut recovers.

Home recovery is measured in weeks to months rather than days. Cleveland Clinic describes a typical return to normal activities over about 2–3 months, with fatigue often the last symptom to fade. A rough shape of those weeks, drawn from the same patient resources:

• Weeks 1–2 at home: short walks several times a day, small frequent meals, wound care, and no lifting beyond light objects.
• Weeks 3–6: gradually longer walks, appetite improving, return to desk-type work for some people.
• Weeks 6–12: heavier activity reintroduced with the surgeon’s agreement; stamina still building.

Follow-up usually includes blood tests and periodic imaging to watch for recurrence, on a schedule set by the oncology team. If an ostomy was created, a specialist nurse teaches its care before discharge. Weight, energy, and bowel habits are tracked at visits, and any further chemotherapy is timed to when the body has recovered enough to tolerate it. Every timeline above is a range, not a target, and slower progress is not failure.

Can cancer come back after HIPEC surgery?

Yes, it can, and honest teams say so at the outset. HIPEC treats disease in the peritoneal cavity that is present at the time of surgery. It cannot reach cells that have already traveled elsewhere, and it does not change the underlying biology that allowed the cancer to spread in the first place. Recurrence may appear in the abdomen again, in the liver or lungs, or in lymph nodes.

Several factors shape the likelihood. Completeness of cytoreduction is the most consistently reported: patients whose surgery achieved a CC-0 or CC-1 result fare better than those with residual visible disease across the published series summarized by Cleveland Clinic. Tumor grade matters; low-grade appendix tumors behave very differently from high-grade colorectal or gastric cancers. The volume of disease at surgery, captured by the peritoneal cancer index, and the response to any chemotherapy given beforehand also carry weight.

Surveillance after HIPEC is therefore built in. Tumor markers in the blood, such as CEA for colorectal and appendiceal cancers or CA-125 for ovarian cancer, are checked at intervals, alongside CT scans. The schedule varies by cancer type and center.

Recurrence is not always the end of surgical options. Repeat cytoreductive surgery, with or without a second HIPEC, is performed in selected patients, most often those with low-grade appendix disease and a long interval since the first operation. The evidence comes from case series rather than trials, and the decision weighs the added risk of operating in a scarred abdomen against the likelihood of clearing the disease again. Systemic chemotherapy, targeted therapy, or clinical trials are the other paths, and which one fits depends on where and how the cancer has returned.

What people often get wrong about HIPEC

Misunderstandings cluster around a handful of ideas, and clearing them up makes the consultation more productive.

The heated chemotherapy is the main event. In practice, the surgery is. Removing visible tumor takes most of the day and carries most of the risk, and the trial evidence gives surgery the clearer credit. The wash is a supplement aimed at microscopic residue.

HIPEC replaces regular chemotherapy. Usually it does not. Many patients receive systemic chemotherapy before the operation, after it, or both. HIPEC addresses the abdominal lining; intravenous treatment addresses the rest of the body.

The heat itself destroys the cancer. Temperatures of 41–43°C are not enough on their own. Heat sensitizes cells and boosts drug effect; the drug does the damage.

If a center offers HIPEC, the evidence must be settled. As the PRODIGE 7 results show, an experienced team can offer a procedure whose added value is still debated for certain cancers. Asking which trials apply to your cancer type is fair.

Recovery is like other abdominal operations. The scale is different. A 10-hour operation with multiple organ resections typically means 1–2 weeks in hospital and 2–3 months before energy returns, per Johns Hopkins and Cleveland Clinic patient materials.

Being turned down means nothing can be done. Not being a candidate for CRS-HIPEC usually reflects disease pattern or fitness, not a lack of options. Systemic therapy, targeted agents, and trials remain available, and candidacy can be revisited if the picture changes.

Survival numbers online predict your outcome. They describe groups defined by cancer type, era, and selection. Your team’s assessment of grade, disease volume, and completeness of removal is far more informative than a figure from a search result.

Questions to ask your care team before HIPEC

A long consultation goes further with a written list. These questions draw on what surgeons and oncologists report patients most often wish they had asked.

• Based on my scans, how much peritoneal disease do you expect, and how likely is complete removal?
• Which organs might need to be removed or partly removed, and is an ostomy possible? If so, would it likely be temporary?
• What is the evidence for HIPEC in my specific cancer type, and which trials or guidelines are you relying on?
• Would surgery alone be a reasonable alternative, and how would you weigh the added risk of the heated chemotherapy?
• How many of these operations does the team perform each year, and what are its own complication and 30-day mortality figures?
• Will I receive chemotherapy before or after the operation, and how does the timing work?
• Roughly how long might I spend in intensive care and in hospital, and what does the first month at home look like?
• What complications are most likely for someone with my health history, and how would each be managed?
• How will recurrence be monitored, and what would the options be if it occurs?
• Is there a clinical trial I could be considered for instead of, or alongside, standard treatment?
• Who do I call, at any hour, if something worries me after discharge?

Bringing a companion to take notes helps; so does asking whether the tumor board’s discussion can be summarized for you. If the answer to a question is uncertain, a good team will say so rather than reassure. Uncertainty stated plainly is not a warning sign; it is what honest medicine sounds like when the evidence is still developing.

When to call your doctor after HIPEC

The weeks after CRS-HIPEC are when complications tend to surface, and the surgical team will want to hear about changes early rather than late. Seek care promptly, calling the number provided at discharge or going to an emergency department, if any of the following appear:

• Fever, shaking chills, or feeling suddenly and markedly unwell, which can signal infection or a leak from a bowel connection.
• Worsening abdominal pain, a rigid or swollen abdomen, or pain that no longer responds to the prescribed plan.
• Persistent vomiting, inability to keep fluids down, or no bowel movement or gas for several days after having previously passed either.
• Redness, warmth, foul-smelling discharge, or separation at the incision, or cloudy or bloody output from a drain.
• Shortness of breath, chest pain, or a rapid heartbeat, which may indicate a blood clot in the lung or a heart problem.
• Swelling, warmth, or pain in one calf or thigh, a possible sign of a deep vein clot.
• Very little urine over many hours, or dark urine with dizziness, suggesting dehydration or kidney strain.
• Black or bloody stool, or bleeding from the ostomy beyond a light streak.
• Confusion, unusual drowsiness, or fainting.

Lower-grade concerns still deserve a call during working hours: appetite that is not returning, ongoing nausea, unexpected weight loss, or an ostomy with changing output. Teams would rather field a question that turns out to be nothing than hear afterward that a symptom was endured for a week.

Everything described in this article, from candidacy to drug choice to the timing of follow-up, is decided by the surgical and oncology team who know the individual case. Their instructions at discharge override any general timeline, and their judgment is the one to lean on when something feels wrong.

Frequently asked questions

Is HIPEC painful?

Pain after HIPEC comes mainly from the large incision and the extent of surgery, not from the heated chemotherapy itself. Most centers use an epidural or a patient-controlled pump in the first days, then transition to oral options. Discomfort typically eases over the first two to three weeks, though soreness and fatigue can persist for longer while the abdomen heals.

How long does HIPEC surgery take from start to finish?

The full CRS-HIPEC operation commonly runs 8–14 hours according to Johns Hopkins Medicine, with the length driven by how much tumor must be removed. The heated chemotherapy phase itself is much shorter, usually about 30–90 minutes. Families are typically warned that updates may be sparse during such a long day.

Why is HIPEC controversial among cancer doctors?

The debate centers on whether the heated chemotherapy adds benefit beyond the surgery. In the PRODIGE 7 colorectal trial, patients who had complete tumor removal did not live significantly longer when HIPEC was added, and complications were more frequent. Supporters note the trial tested one drug and one cancer type; critics argue observational data cannot rule out selection bias.

Can cancer come back after HIPEC surgery?

Yes. HIPEC treats disease present in the abdominal cavity at the time of surgery and cannot reach cells that have already spread elsewhere. Recurrence risk depends on cancer type and grade, how completely tumor was removed, and disease volume. Surveillance with blood markers and scans is routine, and repeat surgery or systemic treatment may be considered if disease returns.

What is the survival rate after HIPEC surgery?

No single figure applies. In the OVHIPEC-1 ovarian trial, median overall survival was 45.7 months with HIPEC versus 33.9 months without. In the PRODIGE 7 colorectal trial, medians were 41.7 and 41.2 months, a nonsignificant difference. Appendix cancer outcomes come from observational series. Your team can relate these data to your specific situation.

What is HIPEC surgery recovery time at home?

Cleveland Clinic describes a return to normal activities over roughly 2–3 months after a 1–2 week hospital stay. The first weeks at home focus on short walks, small frequent meals, and wound care. Stamina builds gradually, and fatigue is often the last symptom to lift. Any further chemotherapy is timed to recovery.

What is cytoreductive surgery, and is it always done with HIPEC?

Cytoreductive surgery is the removal of all visible tumor from the abdominal lining and affected organs, graded by how much, if any, disease remains. It is the essential first stage of CRS-HIPEC, but it can also be performed alone. Whether to add the heated chemotherapy depends on cancer type, the evidence for that type, and the team’s assessment.

What are the most common HIPEC side effects?

Surgical complications dominate: bowel leak, bleeding, infection, slow return of bowel function, and blood clots. The absorbed chemotherapy can lower blood counts and strain the kidneys in the days after surgery, and nausea is common. Longer-term effects depend on which organs were removed, such as changed bowel habits, an ostomy, or the need for vaccinations after splenectomy.

Who is not a candidate for HIPEC?

People whose cancer has spread beyond the abdominal cavity, whose peritoneal disease is too extensive to remove completely, or whose heart, lung, or kidney function would not tolerate a very long operation are generally not offered CRS-HIPEC. Cancer type matters too. Candidacy can be revisited if systemic chemotherapy shrinks the disease or fitness improves.

Does HIPEC replace intravenous chemotherapy?

Usually not. HIPEC targets the abdominal lining, while intravenous chemotherapy reaches the whole body. Many patients receive systemic treatment before the operation, afterward, or both, depending on cancer type and response. The sequence and timing are set by the medical oncologist in coordination with the surgical team and are individualized to each case.

References

• PubMed: Hyperthermic Intraperitoneal Chemotherapy in Ovarian Cancer (OVHIPEC-1, NEJM)
• PubMed: Cytoreductive surgery plus HIPEC versus cytoreductive surgery alone for colorectal peritoneal metastases (PRODIGE 7, Lancet Oncology)
• PubMed: Randomized trial of cytoreduction and HIPEC versus systemic chemotherapy in colorectal peritoneal carcinomatosis (JCO)

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.