Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy, Part I: Introduction and Indications

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is used to treat peritoneal carcinomatosis, which often is secondary to gastrointestinal and ovarian cancers. During CRS, the surgeon resects cancerous tumors from the peritoneal cavity. During HIPEC, a chemotherapy agent is introduced into a solution that flows in and out of catheters in the abdominal cavity for approximately 90 minutes. The chemoperfusate is heated to 42° C (107.6° F), which kills cancer cells but is nonthreatening to normal cells. A primary goal of combining CRS with HIPEC is to apply targeted regional chemotherapy directly to the peritoneum to destroy residual micrometastatic disease while the tumor burden is minimal and before cancer cells become entrapped by the body's wound-healing processes. Although HIPEC usually is not curative, it can extend a patient's life expectancy three to five years. This is the first article in a two-part discussion of CRS with HIPEC.