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HIPEC is a therapy that's administered to patients
with certain diseases that have spread beyond their
organ of origin.
That includes patients with appendix cancer,
colon cancer, some patients with ovarian or uterine malignancies,
patients with some gastric cancers and mesothelioma.
We select patients who we feel would have the greatest benefit
from it with those diseases that I just discussed.
Within that, the patients are brought to the operating room
and had what's called a cytoreductive surgery.
What that means is,
all the disease that we can see in the abdomen, we remove that.
So if it's from the top of your abdomen by your diaphragm,
if it's on any of your internal organs, or
if it's in your pelvis, we remove that.
Following that, we then give the HIPEC,
which is essentially heated chemotherapy,
up to 42 degrees Celsius for approximately 90 minutes.
Once that's done, the patient then has had a complete
cytoreductive surgery in HIPEC, or HIPEC for short.
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The HIPEC is most effective to treat, first, appendix cancer.
Appendix cancer is rare, but
those patients who have an appendix cancer are the ones who
can receive the most benefit.
Often, in many situations,
surgeons that don't manage these patients, or other physicians,
would recommend simply a colon resection.
However, we know, those of us who treat this,
that often the disease will spread beyond just the appendix.
And so that's the number one group of patients we feel will
benefit.
After that, the next group would include patients with
colon cancers that have spread,
as well as some patients with mesotheliomas.
And so that's a primary malignancy of the peritoneum,
some patients with ovarian cancer, and
then a very select few patients with gastric cancer.
So HIPEC has a wide range of patients that could
benefit from it.
And it's incumbent upon physicians to refer to HIPEC
specialists so we can help decide, along with the patients
and their primary physicians, who would best benefit.
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The best candidate for
HIPEC treatment is a variable question.
It depends upon the disease of origin.
A patient with appendix cancer often can have
a higher amount of disease in their abdomen than someone with,
say, gastric cancer with the same amount of disease.
So it depends upon the disease of origin, that's number one.
The second thing we as physicians that look at
patients for HIPEC look at is, how healthy are you?
Our team at Johns Hopkins looks at patients in
a multi-disciplinary format to try and
make sure that those patients are in the best and
optimal position to undergo a cytoreductive surgery in HIPEC.
So that includes making sure that their nutrition is managed
well, making sure that they are in the best shape physically.
And so we make sure that they have a physical therapist and
do some pre-hab if necessary.
Certainly, if patients have a high burden of disease, we work
with our medical oncologists and/or their medical oncologists
who may have referred them to try and make sure that they
undergo a chemotherapy regimen that will help bring them to
an operation if one would not be an option up front.
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The type of physician that administers HIPEC is typically
a surgeon who carries the title of a surgical oncologist.
And so these are surgeons that have trained in
a cancer program, specifically focusing on cancer.
And so those of us who do it have done extra training within
our fellowships.
Or we have gone elsewhere into other centers that have done it
more, to learn the procedure of a HIPEC.
So generally the surgeon who has undergone nine to ten years of
training to be able to administer HIPEC.
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The benefits of HIPEC are many.
The most important one is we're trying to turn a disease that
typically would carry a heavy burden or sentence to a patient,
and turn it into a chronic disease.
And so, for some patients, especially patients with
appendix cancer or low grade disease, typically when we talk
about cancers we talk about five year survivals.
In appendix cancer we start talking about ten year survival.
And so in those best scenarios patients can expect within 70 to
80% of all comers to be alive at ten years.
This is something that's unheard of in typical medicine.
And so these are the patients that can best benefit.
In other diseases, we try to,
again, convert them into a chronic state.
And so these are patients that otherwise would not be offered
anything but chemotherapy.
And in select situations, they are able to be offered a surgery
and prolong survival, as well as improve quality of life.
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