Cytoreductive Surgery (CRS) and Heated intraperitoneal Chemotherapy (HIPEC)

CRS and HIPEC Care

In general, the three main ways that cancers spread are through blood (this causes distant metastases such as liver, lungs, or bones), through lymphatics, or by direct extension.  If you imagine the abdomen as a room, inside that space, there is a lining called the peritoneum which would be equivalent to “wallpaper covering”.   There is also a fatty “curtain-like” structure called the omentum.  Certain cancers, such as appendix, colon and ovarian, have a propensity for direct extension or ”peritoneal” spread.

Until a few decades ago this condition was considered “terminal” with no hope for cure or surgical intervention.  Over the last several years we have realized that a certain subset of patients will benefit from aggressive surgical intervention.  Though usually lumped together, there are two aspects to this surgery.  The first is the actual surgical removal of all visible disease.  This is called the “cytoreductive” part.  This involves removing all “visible disease”, including the organs involved as long as it is technically possible and safe.  In addition to the omentum and peritoneum, other involved organs such as intestines, spleen, stomach, or gallbladder may have to be removed.  For female patients, our team works with Gynecological Oncologists to remove the uterus and ovaries during the same surgery.  While at times extensive resections are needed, the data show clearly superior outcomes when all visible disease can be removed.  The second part of the surgery is the heated intraperitoneal chemotherapy or “HIPEC” portion.  While it is clearly known that removal of all disease has a distinct survival advantage, the benefits of the heated intraperitoneal chemotherapy are more ambiguous.  Recent data has questioned the benefit of the heated intraperitoneal chemotherapy and there are ongoing trials to try to answer this question.

During the office visit, we will discuss and review indications, outcomes, benefits and potential complication in detail in order to come up with an individualized plan for each patient.