Intraperitoneal hyperthermic chemoperfusion
Intraperitoneal hyperthermic chemoperfusion (IPHC) is a type of hyperthermia therapy used in combination with surgery in the treatment of advanced abdominal cancers. In this procedure, warmed anti-cancer drugs are infused and circulated in the peritoneal cavity (abdomen) for a short period of time. The chemotherapeutic agents generally infused during IPHC are mitomycin-C and cisplatin.
IPHC is also called hyperthermic intraperitoneal chemotherapy (HIPEC), intra-abdominal hyperthermic chemoperfusion, intraoperative chemohyperthermic peritoneal perfusion (CHPP), or the Sugarbaker technique, after Paul Sugarbaker, developer and advocate of this procedure.
IPHC is generally used after surgical removal of as much cancer as possible (debulking), which may include the removal of all involved peritoneal areas. These procedures can be 8–10 hours long and carry a significant rate of complications. IPHC is used as a viable solution for certain advanced stage tumors in the abdomen that have spread many small tumors throughout the abdomen, when surgery is not likely to be possible or effective. It can also be applied, during surgery, directly on the area, for those whose abdominal cancer is advanced but is still considered surgically resectable, as an alternative to surgery and traditional chemotherapy alone.
- Mucinous Adenocarcinoma of Appendix
- Low-Grade Sarcoma
The procedure is divided into three stages:
- Exploration: Here the surgeon will open the abdomen evaluate the peritoneal cancer.
- Debulking: In the debulking, or cytoreduction, phase of the procedure the surgeon will remove the visible tumor implants. However, even when all of the visible tumor is removed it is possible for microscopic cancer cells to still remain. The final stage of the procedure is meant to eliminate those cells.
- Chemoperfusion: Here the abdominal cavity is rinsed with a heated chemotherapy solution. Unlike systemic chemotherapy that is delivered in the blood stream, throughout the whole body, the chemotherapy in the HIPEC procedure is largely isolated in the peritoneal cavity. Therefore, a much higher concentration of chemotherapy can be utilized, while the toxicity and side-effects associated with systemic chemotherapy are minimized.
- Esquivel, Jesus (2010). "Technology of Hyperthermic Intraperitoneal Chemotherapy in the United States, Europe, China, Japan and Korea". In Vincent T. DeVita Jr., Theodore S. Lawrence, Steven A. Rosenberg. Cancer: Principles & Practice of Oncology—Annual Advances in Oncology, Volume 1. Lippincott Williams & Wilkins. pp. 188–193. ISBN 978-1-4511-0314-4.