HIPEC is a type of treatment for cancers that have spread within your abdomen. Doctors surgically remove the tumor and then pump heated chemotherapy drugs into your abdominal cavity.

Hyperthermic intraperitoneal chemotherapy (HIPEC) is an intensive procedure doctors may recommend if you have cancer that has spread to your abdomen from other parts of your body. Breaking down the name of the procedure, we get:

  • Hyperthermic: heated or hot
  • Intraperitoneal: inside your peritoneal (abdominal) cavity, which holds organs such as your liver, stomach, and intestines
  • Chemotherapy: a type of chemical drug therapy used to kill cancer cells

HIPEC can potentially improve survival in people who need it. In most cases, the goal of HIPEC is to extend survival rather than to try to cure the cancer.

This article examines HIPEC in more detail, including when doctors use it, what to expect during the procedure, and what the potential risks are.

Doctors combine HIPEC with surgery to treat cancers that have spread to your abdominal cavity from other areas. The spread of cancer to distant body parts is known as metastasis, and the new tumors are called metastatic cancer.

HIPEC is often a palliative treatment, meaning that it focuses on improving survival or reducing symptoms when the cancer is not considered curable.

HIPEC allows doctors to deliver more chemotherapy than traditional intravenous (IV) chemotherapy treatment, which is given directly into a vein. And because less of the medication enters your bloodstream during HIPEC, it can reach areas with cancer more effectively while causing fewer side effects than traditional chemotherapy.

Researchers are continuing to compare the outcomes of HIPEC with those of other treatments, including surgery alone, for many types of cancer. The level of evidence that HIPEC is an effective treatment varies between cancer types.

Your doctor may recommend HIPEC to treat the following metastatic cancers:

Doctors may also use HIPEC for primary peritoneal cancer, which is cancer that starts in the lining of your abdominal cavity. But cancer rarely starts there.

Who is a good candidate for HIPEC?

To be a good candidate for HIPEC, you need to be in good enough overall health to handle intense surgery, and you must have tumors in your abdominal cavity that either started there or spread from other organs. Doctors often perform many tests to determine whether you’re a potential candidate, such as:

There does not seem to be any benefit to HIPEC if doctors can’t completely remove the tumor surgically. And HIPEC is not suitable for you if you have an allergy to certain chemotherapy drugs.

Treatment with HIPEC usually involves two phases: cytoreductive surgery (surgery to remove the visible tumor) and HIPEC administration to help destroy cancer cells that are not visible.

Here’s a general idea of what to expect:

  1. You’ll receive general anesthesia through an IV. An anesthetist or anesthesiologist often administers it through a vein in your arm or wrist.
  2. Your surgeon will make an incision through your abdomen to view any tumors you have.
  3. After removing all visible tumors, your surgeon will insert a catheter containing chemotherapy drugs into your abdominal cavity. This catheter will be attached to a perfusion machine that heats the chemotherapy drugs.
  4. The machine will pump the chemotherapy drugs into your abdomen for 90 to 120 minutes. Your surgeon will then drain your abdominal cavity and rinse your abdomen with a salt solution.
  5. Your surgeon will close the incisions with clips or stitches and cover the wounds with bandages.

HIPEC generally causes fewer side effects than traditional chemotherapy since less of the medication reaches your bloodstream. The possible risks are similar to those of other intensive abdominal surgeries and can include:

The risk of complications is similar to those of other complex abdominal cancer surgeries, such as:

The effectiveness of HIPEC depends on factors such as:

  • the type of cancer you’re treating
  • the subtype of the cancer
  • whether you’ve developed complications

Research is ongoing to learn how HIPEC compares with other procedures. The success rates for HIPEC vary between cancer types.

For example, HIPEC has become the standard of care for cancers that have spread from the appendix or mesothelium to the peritoneum. The 5-year survival rates for these cancers when treated with HIPEC have improved from less than 10% to 50% to 90%.

Some research on HIPEC’s effectiveness has been conflicting. For example, while some research suggests that it improves the outlook for advanced ovarian cancer, multiple studies have found that HIPEC has no greater benefit than the current standard of care (surgery and IV chemotherapy).

Most people will need to spend 10 to 14 days in the hospital after a HIPEC procedure. You’ll likely need to have a urinary catheter and nasal feeding tube in place for several days.

It may take 6 to 12 months for you to recover to your presurgical levels. During this time, you’ll likely have regular follow-ups with your surgical team.

Doctors often use HIPEC as a palliative treatment to ease symptoms and extend life expectancy in people with advanced cancer.

Your life expectancy after HIPEC depends on factors such as:

  • the type and extent of your cancer
  • your overall health
  • the success of your procedure

In a 2023 study, researchers examined the survival of people at a single treatment center in North Carolina who received HIPEC to treat mesothelioma that had spread to the peritoneum. Half of the people treated lived at least 3.3 years, and a quarter lived at least 10.6 years.

Is HIPEC surgery worth it?

Cytoreductive surgery followed by HIPEC has become the treatment of choice for ovarian, stomach, or colorectal cancer that has spread to the abdominal cavity. However, factors such as finances, overall health, and personal preference might influence your or your loved one’s decision on whether to undergo HIPEC.

What is the survival rate for hyperthermic intraperitoneal chemotherapy?

The goal of HIPEC usually is not to cure the cancer but instead to help improve your overall survival. Research suggests that HIPEC can improve the 5-year survival rate of certain cancers to as high as 50% to 90% when it used to be less than 10%.

Experts estimate that 1% to 5% of people who undergo HIPEC die within 30 days of the procedure.

How painful is HIPEC surgery?

You’ll receive general anesthesia before your surgery and won’t feel any pain during the surgery itself. It’s typical to have some degree of pain in the days to weeks after your procedure. However, your doctor will likely prescribe pain medications to reduce this discomfort.

HIPEC (including cytoreductive surgery) involves surgically removing tumors from your abdominal cavity and pumping in heated chemotherapy drugs to help destroy any remaining cancer cells.

The goal of HIPEC is usually to prolong survival rather than to cure the cancer. It has become the standard treatment for some types of cancer that have spread to the abdominal cavity. Researchers continue to investigate how HIPEC’s effectiveness compares with the effectiveness of other treatments.