HIPEC Surgery in India: Treatment, Cost, Procedure and Recovery

HIPEC stands for Hyperthermic Intraperitoneal Chemotherapy. It is a specialised cancer treatment in which heated chemotherapy is circulated directly inside the abdominal cavity, usually after surgeons remove visible cancer deposits through cytoreductive surgery (CRS). It is primarily used for selected cancers involving the peritoneal lining.

The full form of HIPEC is Hyperthermic Intraperitoneal Chemotherapy. Hyperthermic means heated, intraperitoneal means inside the abdominal cavity, and chemotherapy refers to medicines used to destroy or control cancer cells.

CRS, or cytoreductive surgery, involves removing visible cancer deposits from the abdominal cavity. HIPEC involves circulating heated chemotherapy inside the abdomen after surgical removal of visible disease. Both procedures are commonly combined for the treatment of selected peritoneal malignancies.

HIPEC may be considered for selected patients with pseudomyxoma peritonei, peritoneal mesothelioma, ovarian cancer, colorectal cancer with peritoneal metastases, gastric cancer with peritoneal metastases and certain appendiceal malignancies. The evidence and indications differ for each cancer type.

Some patients with stage IV cancer may be eligible if the disease is predominantly confined to the peritoneum and complete cytoreduction is achievable. However, widespread metastases involving multiple distant organs may make the procedure unsuitable. Stage alone does not determine eligibility.

There is no single success rate for HIPEC surgery. Outcomes depend on cancer type, tumour burden, PCI score, completeness of cytoreduction, tumour biology and patient fitness. A specialist should explain survival and recurrence data relevant to the patient's specific diagnosis.

In selected patients with certain peritoneal malignancies, complete cytoreductive surgery combined with an appropriate HIPEC regimen may offer the possibility of long-term remission and potentially curative treatment. However, recurrence remains possible, and not every patient benefits.

The operation can take several hours and may last approximately 6–12 hours or longer in particularly complex cases. The duration depends on the extent of tumour deposits, organs requiring removal, complexity of reconstruction and HIPEC protocol.

Hospitalisation commonly lasts around 1–3 weeks, but it can be shorter or considerably longer depending on the procedure and recovery. Patients who experience complications, delayed bowel recovery or infections may require additional hospital care.

Patients receive general anaesthesia during surgery and pain-management treatment afterwards. Abdominal discomfort is expected following extensive surgery, but it is managed using appropriate medications, monitoring and supportive care.

Commonly used drugs include mitomycin C, cisplatin, oxaliplatin and doxorubicin. The drug selection depends on the cancer type, treatment protocol, kidney function and the treating centre's experience.

HIPEC and conventional chemotherapy have different roles. HIPEC provides local chemotherapy inside the abdomen, whereas systemic chemotherapy treats cancer throughout the body. Some patients may require both approaches. The best treatment depends on the primary cancer and available clinical evidence.

Selected patients with stage III epithelial ovarian cancer may be considered for HIPEC during interval cytoreductive surgery after neoadjuvant chemotherapy, particularly when the disease is stable or responding. It is not routinely recommended for every ovarian cancer patient or every recurrence.

Selected patients with colorectal cancer that has spread to the peritoneum may be considered for cytoreductive surgery. However, ASCO does not recommend adding oxaliplatin-based HIPEC to CRS for colorectal peritoneal metastases. The exact treatment protocol should be discussed with a specialist.

PCI stands for Peritoneal Cancer Index. It measures the extent of cancer within the abdominal cavity by dividing the abdomen into 13 regions and scoring tumour deposits in each region. The score ranges from 0 to 39. A higher score often indicates more extensive disease.

Potential complications include infection, bleeding, kidney injury, bowel leakage, intestinal obstruction, blood clots, respiratory problems, electrolyte imbalances and chemotherapy-related toxicity. Serious complications can occur, which is why specialist surgical and intensive-care facilities are essential.

Initial hospital recovery may take several weeks, while complete recovery can take a few months. Recovery depends on the extent of surgery, organ resections, nutritional status, complications and the patient's overall health.

In standard CRS-HIPEC treatment, HIPEC is combined with cytoreductive surgery. There are other intraperitoneal chemotherapy approaches, including PIPAC, but they are different procedures with different indications. The appropriate approach depends on the diagnosis and treatment objective.

In open HIPEC, the abdominal cavity remains accessible during chemotherapy circulation, allowing manual distribution of the solution. In closed HIPEC, the abdomen is temporarily closed and the heated chemotherapy circulates through specialised tubes. Both are established delivery techniques.

India has specialist cancer centres and surgical oncology teams involved in CRS-HIPEC treatment and peritoneal surface malignancy care. Patients should confirm the current availability of the procedure, the experience of the individual surgeon and the hospital's postoperative critical-care facilities.

There is no single fixed cost for HIPEC surgery in India. The final estimate depends on cancer type, disease extent, surgical complexity, chemotherapy drugs, ICU stay and hospitalisation. A hospital can provide a more accurate estimate after reviewing the patient's medical records and imaging.

Yes, international patients can seek specialist evaluation and treatment in India. However, they should submit medical records for preliminary review before travelling. Fitness to travel and the timing of surgery must be determined by the treating medical team.

Hair loss is not an inevitable consequence of HIPEC. Some chemotherapy drugs used during perfusion may be absorbed systemically, but the risk of hair loss depends on the drug, dose and whether the patient also receives systemic chemotherapy.

Yes. Cancer recurrence is possible even after complete cytoreductive surgery and HIPEC. The risk depends on tumour biology, cancer type, completeness of cytoreduction and other clinical factors. Regular follow-up and surveillance are important.

Age alone does not determine whether a patient can undergo HIPEC. Doctors assess overall fitness, frailty, heart and lung function, kidney function, nutritional status and the expected benefits of surgery. Some elderly patients may be suitable, while others may face unacceptable risks.

HIPEC uses heated liquid chemotherapy circulated inside the abdomen, generally during cytoreductive surgery. PIPAC uses pressurised aerosolised chemotherapy delivered laparoscopically. The procedures have different treatment objectives and should not be considered interchangeable.

Some patients may require additional systemic chemotherapy after surgery, depending on their cancer type, pathology results, previous treatments and recurrence risk. Others may be advised surveillance. The decision is individualised by the multidisciplinary oncology team.

Patients should consult a surgical oncologist with specific experience in peritoneal surface malignancies and CRS-HIPEC. The evaluation should also involve medical oncology, radiology, pathology and anaesthesia specialists as appropriate.

Extensive liver metastases may make CRS-HIPEC unsuitable in many situations. However, selected patients with limited liver involvement may be assessed individually at specialist centres. The decision depends on the primary cancer, distribution of disease and whether all relevant tumour deposits can be treated.

Patients should ideally provide their histopathology report, recent CT or MRI images, previous operation notes, chemotherapy records, discharge summaries, tumour marker results and current blood investigations. Complete documentation helps the specialist assess whether CRS-HIPEC is appropriate.

The Peritoneal Cancer Index (PCI) is a scoring system that measures the extent and distribution of tumour deposits inside the abdominal cavity across 13 regions. Scores range from 0 to 39. A higher PCI indicates more extensive disease and may affect eligibility for cytoreductive surgery. However, there is no universal PCI threshold — the acceptable score depends on the cancer type, disease location and surgical expertise.