What Is HIPEC Surgery? A Complete Guide to Heated Chemotherapy and Treatment in India

HIPEC surgery is an advanced cancer treatment in which heated chemotherapy is circulated directly inside the abdominal cavity to target microscopic cancer cells that may remain after visible tumours have been surgically removed.

HIPEC stands for Hyperthermic Intraperitoneal Chemotherapy. It is performed alongside a major operation called cytoreductive surgery (CRS), which removes visible cancer deposits from the abdominal cavity. The treatment is primarily used for selected cancers affecting the peritoneum — the thin membrane lining the abdominal cavity.

Unlike conventional chemotherapy, which travels through the bloodstream, HIPEC delivers chemotherapy directly into the abdominal cavity. The solution is heated to approximately 41–43 °C and circulated for a prescribed period after the surgeon has removed visible cancer deposits.

HIPEC is the abbreviation for Hyperthermic Intraperitoneal Chemotherapy. Each word describes an important part of the treatment: Hyperthermic means heated to a controlled temperature; Intraperitoneal means administered inside the abdominal cavity; Chemotherapy refers to medicines used to destroy or control cancer cells.

The peritoneum is a thin membrane lining the abdominal cavity and covering many organs within it. When cancer cells detach from a primary tumour and attach to these surfaces, the condition is known as peritoneal metastasis or peritoneal carcinomatosis.

The surgeon removes visible cancer deposits from the abdominal cavity, which may include affected sections of the peritoneum, omentum, bowel or other organs. The goal is complete macroscopic cytoreduction — no visible tumour remaining.

Once CRS is completed, heated chemotherapy is circulated throughout the abdominal cavity using a specialised perfusion machine. The solution is heated to approximately 41–43 °C and circulated for 30–120 minutes, then drained before the surgical team completes the operation.

Laboratory and clinical research suggests that heat can increase the activity of certain chemotherapy agents against cancer cells. Direct delivery into the abdominal cavity allows the treatment solution to contact peritoneal surfaces where microscopic cancer cells may remain after tumour removal. The specialised equipment controls temperature, circulation and exposure duration throughout the procedure.

Important: Heating chemotherapy does not guarantee destruction of all cancer cells or that it is automatically more effective than conventional chemotherapy. Its clinical value must be evaluated separately for each cancer type and patient.

CRS-HIPEC is an established specialist treatment approach for patients with resectable pseudomyxoma peritonei. International consensus recommendations support combining cytoreductive surgery with HIPEC in appropriately selected patients.

Selected patients with stage III ovarian cancer who have received neoadjuvant chemotherapy and are undergoing interval cytoreductive surgery may be considered for HIPEC. The OVHIPEC-1 clinical trial demonstrated improved survival outcomes in its selected patient population.

Selected patients with isolated colorectal peritoneal metastases may be considered for cytoreductive surgery. However, the ASCO guideline recommends against adding oxaliplatin-based HIPEC to CRS for colorectal peritoneal metastases. Indian specialists should also consider INDEPSO–ISPSM consensus recommendations.

CRS-HIPEC may be considered in highly selected patients with limited gastric peritoneal disease, carefully selected patients with diffuse malignant peritoneal mesothelioma, and certain appendiceal malignancies depending on histological type. Treatment planning is particularly important as different tumour types behave very differently.

HIPEC is a major operation. Patient selection is one of the most important aspects of treatment. The specialist team generally considers the cancer type and histopathology, the distribution of tumour deposits, the Peritoneal Cancer Index (PCI), the possibility of complete tumour removal, general health and organ function, and previous cancer treatment history.

The PCI is a scoring system used to assess the extent of cancer within the abdominal cavity. The abdomen is divided into 13 regions, each assigned a lesion-size score. The combined score ranges from 0 to 39. A higher PCI generally indicates a greater tumour burden, though there is no universal threshold for every cancer type.

Although both treatments use anticancer medicines, their delivery methods and treatment objectives differ. Conventional chemotherapy is usually given intravenously to treat cancer throughout the body. HIPEC delivers heated chemotherapy directly into the abdominal cavity during surgery to target microscopic disease on abdominal surfaces. Some patients may require both. The appropriate approach depends on cancer type and clinical evidence.

PIPAC (Pressurised Intraperitoneal Aerosol Chemotherapy) delivers chemotherapy as a pressurised aerosol via laparoscopy and does not itself remove visible tumours through cytoreductive surgery. HIPEC delivers heated liquid chemotherapy into the abdominal cavity during CRS. They have different clinical applications and should not be considered interchangeable.

The chemotherapy drug used during HIPEC depends on the cancer type, treatment protocol and patient-specific considerations. Common agents include Mitomycin C (selected appendiceal and colorectal protocols), Cisplatin (selected ovarian protocols), Oxaliplatin (certain colorectal protocols — ASCO recommends against in colorectal CRS setting), and Doxorubicin (selected specialised protocols). These drugs are not interchangeable; selection depends on tumour type, evidence, kidney function and institutional protocol.

CRS-HIPEC is an established specialist treatment supported by international consensus recommendations for resectable pseudomyxoma peritonei.

The OVHIPEC-1 randomised clinical trial demonstrated improved recurrence-free and overall survival in selected stage III ovarian cancer patients undergoing interval cytoreductive surgery after neoadjuvant chemotherapy. These findings apply to the selected trial population and should not be generalised to all ovarian cancer patients.

The PRODIGE 7 trial did not demonstrate an overall survival benefit from adding oxaliplatin-based HIPEC to CRS for colorectal peritoneal metastases. The ASCO guideline consequently recommends against adding oxaliplatin-based HIPEC to CRS in this setting. The guideline supports consideration of complete CRS combined with systemic chemotherapy in carefully selected patients.

Recovery after CRS-HIPEC is generally longer than routine abdominal surgery. Patients may require several weeks of hospital-based care followed by a gradual recovery period at home.

The cost of HIPEC surgery in India varies according to the cancer type, extent of disease, complexity of cytoreductive surgery, chemotherapy protocol and postoperative requirements. There is no single fixed price applicable to every patient.

Major cost components include: specialist consultation, diagnostic investigations (CT, MRI, PET-CT, laboratory testing), cytoreductive surgery (surgeon, theatre and materials), HIPEC treatment (perfusion equipment, chemotherapy and consumables), anaesthesia, ICU admission, hospitalisation, medicines and any additional procedures required.

GAF Healthcare facilitates international patients seeking specialised cancer treatment in India. Our priority is to help patients access an appropriate specialist opinion rather than encouraging surgery without proper medical assessment. Patients may be advised to undergo systemic chemotherapy, another surgical approach or supportive treatment instead of HIPEC.

Patients from Tanzania, Kenya, Ethiopia, Uganda, Zambia, Nigeria, Iraq and other countries can approach GAF Healthcare for assistance coordinating their medical evaluation and treatment journey in India.

Medical Disclaimer: This article is intended for educational and informational purposes only. It does not replace consultation with a qualified oncologist or surgical oncologist. CRS-HIPEC is a complex procedure with significant risks. Treatment suitability, expected outcomes and alternative treatment options must be assessed individually by an experienced multidisciplinary medical team.