HIPEC for Cancer of the Abdominal Lining
Cytoreductive surgery with heated chemotherapy for appendix, colorectal, ovarian and gastric cancer
When cancer spreads to the peritoneum, the thin lining of the abdominal cavity, patients are often told nothing more can be done. For selected patients that is not true. Cytoreductive surgery with HIPEC removes all visible cancer and then bathes the abdomen in heated chemotherapy to treat what remains. Dr. Papenfuss co-founded the HIPEC program at St. Luke's in Milwaukee in 2018; it performs more than 40 procedures a year and treats patients from across Wisconsin and neighboring states.
What it is
Peritoneal cancer means tumor deposits scattered across the abdominal lining and the surfaces of organs. Chemotherapy given through a vein reaches the peritoneum poorly, which is why this pattern of spread has historically been so hard to treat. HIPEC (hyperthermic intraperitoneal chemotherapy) delivers a high concentration of chemotherapy directly to the surfaces where the cancer lives, heated to about 42 degrees Celsius to make it more effective, for 60 to 90 minutes at the end of the operation.
Who it is for
Appendix cancer and pseudomyxoma peritonei: the strongest indication. Mucinous tumors of the appendix spread through the abdomen as jelly-like deposits, and cytoreduction with HIPEC is the standard of care and can be curative.
Colorectal cancer with limited peritoneal spread: complete surgical removal of the deposits offers long-term survival for well-selected patients; the added benefit of HIPEC is being refined in current trials and is discussed case by case.
Ovarian cancer: HIPEC at the time of interval surgery after chemotherapy improves outcomes in selected patients, performed jointly with gynecologic oncology.
Mesothelioma of the peritoneum and selected gastric cancer with low-volume spread.
Candidacy depends on how much disease there is (the peritoneal cancer index), whether all of it can be removed, and the patient's fitness for a long operation.
What the operation involves
Cytoreductive surgery removes every visible deposit, which may mean stripping the peritoneal lining and removing parts of the bowel, spleen, omentum or other organs. It is a long operation, often 8 to 12 hours, followed by HIPEC and a hospital stay of one to two weeks. Recovery takes several weeks to months. Patients are evaluated by the whole team beforehand, including anesthesia and nutrition, and some receive chemotherapy first.
Dr. Papenfuss's approach
The St. Luke's HIPEC program is multidisciplinary by design: surgical oncology, gynecologic oncology, medical oncology, pathology and a dedicated perfusion team. Every patient is reviewed in conference, and those who are not candidates for HIPEC are offered systemic therapy and, where available, clinical trials. Learn more about the program at Advocate Health: aurorahealthcare.org/services/cancer/cancer-treatments/hipec-surgery
When to get a second opinion
If you have appendix cancer, or colorectal or ovarian cancer with spread to the abdominal lining, and HIPEC has not been discussed, a review by a HIPEC program is warranted. A records review can happen before you travel.
Call 414-649-3240 to request a consultation.
Learn more about the HIPEC program at Aurora Health Care.
This page is general information, not medical advice for any individual patient.