However, surgery, chemotherapy, radiotherapy, immunotherapy, etc. Despite the treatments, the disease is not limited to the organ from which it originates, but can also spread to other intra-abdominal organs and the peritoneum that covers the abdominal wall. The drugs administered intravenously to the patient cannot reach the peritoneal areas affected by cancer at the desired level and the treatment is insufficient.

At this point where the desired response from classical cancer treatment cannot be obtained, “cytoreductive surgery (SRC) and intra-abdominal warm chemotherapy (HIPEC)” (cytoreductive surgery + hyperthermic intraperitoneal chemotherapy – CRS + HIPEC) treatment, which is a method that will both prolong the patient’s survival and improve comfort. comes to the fore.

In this treatment, which should be decided to be applied with a multidisciplinary approach (oncologist, surgeon, radiologist, etc.), all cancer cells are eliminated by combining surgery and heated chemotherapy applied to the abdominal cavity. The goal of treatment is to achieve long-term survival and even cure in some patients. 

How is it applied?

All organs (ovary, large intestine, stomach, spleen, etc.) affected by cancer in the abdomen and the peritoneum covering the abdominal wall are removed, and complete or nearly complete tumor removal (cytoreductive surgery) is performed so that no visible (macroscopic) tumor tissue remains.

Then, 4 drains placed in the abdomen are connected to the chemotherapy pump, and chemotherapy drugs at a temperature of 42-43⁰C are delivered to each region of the abdomen. At the end of the procedure, which lasts between 60-90 minutes, approximately 3lt of chemotherapy fluid given to the abdomen is withdrawn and the operation is terminated.

Why are drugs given by heating?

Kemoterapi ilaçlarının ısıtılarak uygulanması, ilacın tümör dokusu içine nüfus etmesini kolaylaştırarak etkinliğini arttırır. Ayrıca yüksek ısı da anti-tümör etkiye sahiptir ve ısı ilacın karın içindeki tüm yüzeylere eşit dağılımına katkı sağlar.

Which types of cancer are used?

It is most commonly applied in peritoneal cancer or mesothelioma originating from peritoneal cells, ovarian cancer in women, appendix, colon and rectum cancer. 

How effective is it?

This treatment increases long-term survival with the right patient selection. Peritoneal, appendix, ovarian cancers in women and colorectal cancers are the disease groups with the most significant effect on long-term survival. 5-year survival reaches >90% in peritoneal mesothelioma. 

In what case is it not done?

This treatment is not performed when cancer spreads to tissues and organs outside the abdomen (lung, bone, brain, etc.). HIPEC can be applied if there is spread in the liver in the form of 3 or less and removable foci. However, in case of extensive liver involvement, the procedure is not performed. In addition, HIPEC cannot be performed if there is small bowel involvement such that there is not enough intestine to survive if surgery is performed.