HIPEC Surgery for Mesothelioma

What Is HIPEC Surgery?

HIPEC is an effective treatment for patients with peritoneal mesothelioma. The procedure combines two types of mesothelioma cancer treatments: tumor-removing surgery and heated chemotherapy. For many peritoneal mesothelioma patients, HIPEC has improved survival.

Key Facts About HIPEC for Mesothelioma

1. HIPEC has the best survival rate of any treatment for peritoneal mesothelioma.
2. After HIPEC surgery, the 5-year survival rate for peritoneal mesothelioma is 69%.
3. HIPEC causes fewer side effects than whole-body or systemic chemo.
4. HIPEC can safely give higher drug doses than whole-body chemo.

Because the chemotherapy portion of the HIPEC procedure targets only the mesothelioma tumors in the abdomen, its effects are not as severe as those involving systemic chemo that affects the whole body.

“When I had the HIPEC procedure, the cancer was gone,” said peritoneal mesothelioma survivor Tamron Little. “The chemotherapy did what it was intended to do, and it killed the cancer. Since the HIPEC procedure, I have not had any cancer recurrences.”

How Does HIPEC Surgery Treat Mesothelioma?

Doctors first use tumor-removing surgery, also known as cytoreductive surgery, to eliminate as many of the tumors as possible. Next, doctors apply heated chemotherapy drugs directly in the abdominal cavity using a specialized machine. Some mesothelioma patients, including Tamron, call the procedure the “shake and bake.”

“[It’s called shake and bake] because they go in there, they take the tumor out, and then they wash the inside of your abdomen with this solution,” said Tamron. HIPEC surgery helps patients live longer and eases their symptoms. Cytoreductive surgery plus HIPEC has the best survival rate for peritoneal mesothelioma.

Using tumor-removing surgery with HIPEC works better than using standard chemo alone. It also has fewer side effects. Traditional chemo affects the whole body. HIPEC only uses local chemotherapy. It targets the cancer’s specific location. Also, HIPEC heats the chemotherapy drugs. This lets cancer cells absorb them better.

Step 1: Cytoreductive Surgery

A mesothelioma cytoreduction aims to remove as many cancer cells as possible. This includes all visible tumors. Both radical and minimally invasive tumor-removing surgery can improve survival in the right patients.

Radical or extreme tumor-removing surgery is often used to remove tissue likely to have cancer cells. This can include removing part of the lining of the abdomen in a procedure called a peritonectomy. Surgeons may also remove part of the intestines, the greater omentum and some lymph nodes. The greater omentum is the fatty tissue covering the organs.

Research shows that for some patients minimally invasive cytoreductive surgery may be a good option. This is true for those with a low peritoneal cancer index. Some studies say that less invasive surgery leads to shorter hospital stays. There are also fewer surgical complications.

Step 2: Chemotherapy Bath

Right after surgery, mesothelioma doctors use heated chemo. It kills any remaining cancer cells in the peritoneum. Chemo drugs bathe tissue in the abdominal cavity. A HIPEC machine heats the chemotherapy drugs. It then uses catheters to circulate them through the abdomen. The machine pumps the drugs into and out of the body.

It usually takes 1 hour to deliver the chemo. Once HIPEC is complete, surgeons drain the drugs. They rinse the abdomen with saline, then close the incisions.

What Are the Benefits of HIPEC for Mesothelioma Patients?

HIPEC improves life expectancy for peritoneal patients. This includes both overall and progression-free survival. A 2022 study published in the journal Anticancer Research noted HIPEC’s effect on median overall survival rates. When chemo alone was the standard treatment, the rate was 12-28 months. With the introduction of cytoreductive surgery and HIPEC, the rate increased to 34-92 months.

Benefits of HIPEC for Peritoneal Patients

• Can ease pain and other tumor-related symptoms
• Higher doses can be given than with systemic chemo
• Life expectancy, survival and prognosis can improve
• Targets chemo directly to affected area
• This approach allows chemo to reach more areas

Dr. Edward Levine spoke with us about HPEC. He’s the chief of surgical oncology at Wake Forest Baptist Medical Center. He said, “The best survival times recorded to date are with cytoreductive surgery and HIPEC compared to chemo.” Dr. Levine added, “Unfortunately, it’s not curative for everyone. But we do have a number of successes.”

He explained survival times vary from patient to patient. But he said he’s personally treated patients who have survived “…15, 16 or more than 20 years out.” He specifically noted his patient, Tamron. She has survived more than 15 years since her HIPEC procedure. Tamron shares, “It was hard. It was hard physically. It was hard mentally. But it was worth it.”

Risks and Side Effects of HIPEC for Mesothelioma

The risk of side effects from chemo and HIPEC for peritoneal mesothelioma is 4.5% to 19%. HIPEC surgery usually has fewer and milder side effects than chemo. 

Most chemo side effects are minor. But serious complications can occur. In some patients, HIPEC can cause kidney and liver damage. It may also lead to metabolic imbalances and bone marrow suppression. Both the digestive and circulatory systems can be affected.

Serious HIPEC complications are rare. However, there can be bleeding, clots, infections, and sepsis. There can also be leaks in the intestines, kidney failure and pancreatitis.

Research shows that a protein’s rise after HIPEC can predict poor outcomes. High C-reactive protein levels may mean a higher risk of complications.

Recovery From HIPEC Surgery

Recovery from HIPEC surgery typically takes 4 to 12 weeks. The more extensive the surgery, the longer the recovery. Some medical centers use a system for “enhanced recovery after surgery.” This can improve pain control and reduce recovery time.

Many patients need a feeding tube during recovery. HIPEC causes a temporary stop in bowel function. You’ll stay in the hospital until your bowels function again. This usually takes at least a week.

You may spend time in an intensive care unit. During your recovery, doctors will run tests and scans. They’ll check your recovery and response to HIPEC.

Who Is Eligible for HIPEC Treatment?

Not all patients are eligible for surgery. Several factors affect who will benefit most from HIPEC. They also affect who will have fewer side effects.

HIPEC is best for younger, healthy patients. They must be able to endure a long surgery and recovery. Eligibility also depends on how far tumors have spread beyond the abdomen. The chance of success in surgery depends on removing all cancer cells.

HIPEC Mesothelioma Patient Eligibility

• Must be healthy enough for surgery
• Can’t have heart disease or other serious chronic conditions
• No more than one complete or partial bowel obstruction
• Must score low on the peritoneal cancer index. This estimates cancer growth and spread.
• Must have an epithelial cell type. Other mesothelial cell types may be considered

Doctors will assess your health. They refer to this as your “performance status.” Patients who are healthy except for their cancer are more likely to qualify. Those with heart or liver disease or serious chronic illnesses aren’t usually candidates. People with tumors in some abdominal areas also aren’t good candidates.

In a study Dr. Paul Sugarbaker conducted in 2021, he found age had the greatest impact on survival after HIPEC. The procedure is also more effective on the epithelial cell type.

How to Receive HIPEC Treatment for Mesothelioma?

Patient Advocates at The Mesothelioma Center can help you. They can connect you with centers that offer HIPEC surgery. Many U.S. mesothelioma centers don’t offer HIPEC as a standard treatment. Cytoreductive surgery is complex and needs specialized HIPEC equipment.

You can schedule a surgical consult to learn about HIPEC and if you qualify. During a consult, you’ll meet with the surgeon and team virtually or in person. This lets you ask questions and raise any concerns with the team.

The surgical team then reviews your records to see if you qualify. If so, the surgeon will discuss the risks and benefits of surgery with you. You’ll learn more about the surgery. They’ll cover how to prepare and what to expect during recovery.

Common Questions About HIPEC Surgery for Mesothelioma

Is HIPEC and cytoreductive surgery painful?

Patients often report pain after surgery with HIPEC. Surgical incisions and inflammation can cause pain. Neuropathic or nerve pain may also occur. It’s usually temporary.

How much does HIPEC treatment cost?

Cytoreductive surgery with HIPEC costs about $38,000 to $49,000. A 2024 study in the Annals of Surgical Oncology noted cost trends. It found the median direct cost for cytoreductive surgery and HIPEC was $44,700.

Is HIPEC surgery dangerous?

HIPEC surgery has a 1.1% mortality rate. It’s lower than other high-risk cancer surgeries. A 2020 study in the International Journal of Clinical Oncology supports this. It found the rate of serious complications after HIPEC surgery was 14.7%.

Is HIPEC available for pleural mesothelioma patients?

Hyperthermic intrathoracic chemotherapy is available. HITHOC delivers chemo directly to the lining around the lungs. This is known as the pleural lining.

The late Dr. David Sugarbaker led a study that reported improved survival with HITHOC. For patients who qualified for surgery, survival improved by 12.5 months.

Is HIPEC ever paired with other procedures?

Dr. Paul Sugarbaker pioneered the HIPEC procedure. In a 2022 study, he looked at HIPEC survival rates. He found that HIPEC, and a second procedure, improved survival. The other procedure is normothermic intraperitoneal chemotherapy. NIPEC after HIPEC increased the 5-year survival rate as high as 80%.

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