Hyperthermic (or Heated) Intraperitoneal Chemotherapy (HIPEC) is a state-of-the-art procedure for treating cancers that have spread to the abdomen. In the past, patients with advanced cancers have had few medical alternatives. Today, HIPEC offers a new treatment option – even for people who have been told they have no options.
Froedtert Hospital in Milwaukee, Wis., is a leading cancer center for HIPEC surgery. Our physicians are active in HIPEC research and developing many HIPEC cancer treatment advances. Our Radiology Department is a leader in using advanced imaging technologies in the early detection of cancer, including cancers that can be treated with HIPEC.
HIPEC Video FAQ
Callisia Clarke, MD, and T. Clark Gamblin, MD, MS, MBA, surgical oncologists, explain heated intraperitoneal chemotherapy (HIPEC) in the video FAQ below.
What are the potential benefits of HIPEC surgery?
Cytoreduction and HIPEC surgery offer a lot of benefit to patients who traditionally have not been able to get significant disease control from standard chemotherapy or radiation. Peritoneal malignancies are very challenging cancers, and studies have shown that chemotherapy alone is insufficient in treating patients and their symptoms. But, with cytoreduction and HIPEC surgery, we've been able to offer hope to many patients with this disease and ultimately give them longer overall survival and, in some cases, a cure.
What should I expect after HIPEC surgery?
Recovery after HIPEC varies on an individual basis. In general, our patients will typically leave the hospital in about seven to 10 days after their surgery. After initial surgery, we follow our patients very closely to monitor for complications in the immediate post-operative period as well as for tumor recurrence over time. Initially, we see our patients back every few months or so to do a physical exam. We also get repeat imaging studies to see if there are any new tumors that have developed since our last examination. As you get further and further away from your initial diagnosis without any evidence of disease, we're able to spread out those follow-up visits to more of an annual basis. Long-term quality of life varies depending on the extent of the surgery that was required to remove all of the tumor. In general, in about three to six months after surgery, patients will start feeling as if they're back to their baseline. Here, we have additional resources including physical therapists and dietitians who are dedicated to our HIPEC program that will help patients get back to their baseline faster.
How will the HIPEC team work with my personal physician?
When patients come to our center, sometimes, they’re concerned; they’re coming to an academic medical center, but this isn’t their home. They have a whole team of other physicians out in the community that have taken care of them all their lives. And they worry a little bit about how their team will be integrated with our team. And I would tell you, that’s done in a very personal way – in a very relationship-based way, where phone calls are made to referring doctors and letters are sent and images sent. We really want to allow patients to get most of their care close to home, realizing that coming to an academic medical center for the operation or some form of treatment may be necessary, but in no way are we trying to say we’re the only team to take care of that now. We’re really expanding the team onto our campus here in Milwaukee.
What are the outcomes for patients receiving HIPEC treatment for appendix and other advanced abdominal cancers?
Advanced GI cancer requires a lot of very complex operations. We're very proud of the fact that we've done literally hundreds of patients' operations here in Milwaukee. And we've seen a lot of fabulous results. We've seen patients 17 years out from HIPEC. We've seen patients who come in and say, “three years after my HIPEC, I decided to start my family and now I have a three-year-old with me.” In other words, they turn a corner from worrying about their cancer to getting on with living. And, I just can't tell you how rewarding that is.
Why is it important to choose an experienced HIPEC team for my surgery?
The biggest thing that a patient needs to take into consideration when undergoing HIPEC is the experience of the team that is providing their care. Studies have shown that your incidence of complication decreases significantly when you have your surgery at centers that are more experienced. We are proud to have taken care of hundreds of patients with peritoneal surface malignancies. Because we are a regional high volume center, our complication rates are much lower than national averages.
What types of experts make up the HIPEC team?
When patients come to visit us, they meet a team. Sometimes that’s three or four people, but what they represent, I think, is a team of 40 or 50 individuals that are thinking about their cancer. So, in a multidisciplinary way at a tumor conference, their images are presented, their pathology is discussed; we really lay out a consensus plan for how we’re going to care for these patients. So, I think that the people they meet, while incredibly important to the team, are really just representative of the much, much larger team that’s committed to this cancer.
What is the HIPEC team’s experience in treating patients who have complex abdominal cancers?
Clearly, as we offer this to the Midwest and the U.S., we think about being one of the highest volume centers. In other words, we see these patients, and we see these problems very frequently. They’re not new challenges for us; they’re challenges we welcome, and they’re challenges we understand how to take care of. Some of the operations we offer can carry a lot of potential complications. Some of those complications are unavoidable. But we have to offer a perfect operation, and then, anticipate any challenges that we might see down the road, so that we know if there are complications, they’re not new complications to our team, and they’re ones that we’re well equipped to manage.
HIPEC Procedure Uses Cytoreductive Surgery and Chemotherapy
“Intraperitoneal” means within the peritoneum, which is a membrane that lines the abdominal cavity. There are two parts to the HIPEC procedure:
- Cytoreductive surgery
- At the start of the HIPEC procedure, a surgeon uses a minimally invasive scope called a laparoscope to inspect the inside of a patient’s abdomen.
- If existing cancer tissue can be removed completely, a surgical incision is created.
- The surgeon then works systematically throughout the abdomen to remove all visible tumors.
- Tumor tissue can be removed using several methods, including ultrasonic ablation, thermal ablation (electroevaporative surgery, microwave) and cryoablation (or freezing).
- After all visible cancer tissue has been removed, the surgical team circulates a concentrated chemotherapy solution throughout the abdomen. The purpose is to expose microscopic cancer cells to the cancer-killing drug.
- The chemotherapy solution is heated to approximately 108 degrees Fahrenheit (42 degrees Celsius), which increases the anti-cancer effect. This part of the procedure is sometimes referred to as a “hot chemo bath.”
- The surgical team circulates the solution for approximately 90 minutes, delivering high-dose chemotherapy to cells that coat the lining of the abdomen.
- Afterward, the abdomen is washed with a sterile solution.
The entire HIPEC procedure takes from six to eight hours.
HIPEC Treatment Benefits
HIPEC offers several treatment benefits for patients with cancers that have spread to the abdomen:
- Higher drug concentration. With standard intravenous chemotherapy, cancer drugs are delivered throughout the body, affecting cancerous tumor and healthy tissues. This limits the dose that can be delivered safely. In the HIPEC procedure, cancer drugs are confined to the abdomen. This allows physicians to deliver cancer drugs at a much higher concentration, increasing the chemotherapy’s effectiveness.
- Greater contact with cancer cells. Abdominal tumors usually have a very poor blood supply, so standard chemotherapy delivered through the bloodstream does not reach these tumors easily. HIPEC directly exposes abdominal tumors to anti-cancer drugs.
- Greater tissue penetration. The high temperature of the HIPEC solution causes tiny blood vessels in the abdomen to dilate. This allows the drug to penetrate abdominal tissues more deeply, exposing more microscopic cancer cells to chemotherapy.
- Better targeting of cancer cells. Heat also speeds up the cancer cell cycle, which makes cancer-targeting drugs work even better.
- Fewer side effects. HIPEC confines chemotherapy to the abdomen, with very little delivery of drug to the rest of the body. Patients experience fewer HIPEC side effects than can be associated with chemotherapy.
- Reduced hospital stay. Our physicians have pioneered short stay recovery programs. Through careful anesthesia management and advanced surgical techniques, we have virtually eliminated an intensive care unit (ICU) stay after HIPEC, which is common in many centers worldwide. Patients typically stay in the hospital for about five to 10 days after this operation.
- Minimally invasive operation for eligible patients: Our physicians have developed significant expertise in the technique of laparoscopic HIPEC. This technique is available to patients with early cancers and to patients needing HIPEC for control of ascites fluid in the abdomen.
HIPEC Treatment Outcomes
HIPEC has led to dramatic improvements in outcomes for patients who have challenging cancer diagnoses.
- Increased survival. Studies show that HIPEC significantly increases survival for patients with cancers that have spread to the abdomen. In fact, HIPEC has achieved long-term cures for some patients.
- Cancer as a chronic disease. When a cure is not possible, HIPEC allows physicians to treat cancer less like a terminal condition and more like a chronic disease such as diabetes or high blood pressure. Even as the cancer progresses, physicians can often use HIPEC and other therapies to control the disease and its symptoms.
- Ascites control. Cancers that have spread to the abdomen sometimes cause ascites, which is the buildup of fluid within the peritoneal cavity. This fluid accumulation can lead to swelling of the abdomen, discomfort, pain, difficulty breathing and organ failure. HIPEC is very effective at controlling ascites related to the spread of cancer.
- Low complication rates. Care teams that treat a high number of HIPEC patients have low complication rates. Froedtert Hospital is one of the busier HIPEC centers in the nation, and our HIPEC surgeons’ complication rates are lower than national averages.
- Improved quality of life. Research has shown that HIPEC can help patients maintain their overall quality of life, with significant reductions in pain and distinct gains in emotional health.
- Prevention of bowel obstruction. Patients with advanced abdominal cancers may develop bowel obstructions that can prevent them from being able to eat. Initiated early, HIPEC can prevent bowel obstructions. The HIPEC team also has advanced expertise in the management of patients with bowel obstructions.
Who Is a Candidate for HIPEC?
HIPEC can be used to treat cancers that have spread to the abdomen and several cancer-related conditions:
- Abdominal cancer and cancer-related conditions, including peritoneal cancer such as peritoneal mesothelioma, pseudomyxoma peritonei (PMP) and peritoneal carcinomatosis
- Appendix cancer
- Colorectal cancer
- Gallbladder cancer
- Ovarian cancer
- Pancreatic cancer
- Sarcomas, including GIST tumors and desmoplastic small round cell tumors
- Stomach cancer (gastric cancer)
- Thoracic mesothelioma
HIPEC can also be used as a preventive treatment for patients with cancers at high risk of spreading to the abdomen. Our physicians have pioneered the use of diffusion-weighted MRI technology to detect metastatic abdominal tumors. Early detection of metastatic disease and prompt treatment significantly extend survival for people with these cancers.
HIPEC can be performed safely for a wide range of patients, including elderly people, people who have had previous cancer treatments and patients with other health conditions.
Some patients are initially ineligible for HIPEC because their cancer is too extensive for surgical removal. For many of these patients, targeted chemotherapy initiated by medical oncologists can often shrink their tumors enough to make them candidates for the procedure.
The HIPEC Patient Experience at Froedtert Hospital in Milwaukee
We put patients and their families at the center of HIPEC treatment. Our care pathway has been carefully designed to ensure a smooth treatment journey and the best possible outcomes.
Care navigators. With our patient-centered care model, patients who might be candidates for HIPEC work directly with a new patient coordinator. The coordinator will introduce you to the program, gather your medical records and schedule a physician consultation. An advanced practice provider will review your medical records and coordinate additional appointments. Our goal is to “cluster” appointments for the convenience of patients, especially for individuals and family members traveling to Froedtert Hospital from a distance.
First visit. During your first visit, you will meet with a HIPEC surgeon and other cancer specialists. The entire physician team works together to determine your best treatment course. If HIPEC is right for you, your physician will talk to you about the procedure, discuss the risks and benefits, and explain the recovery process. Your involvement in decision making helps us tailor a treatment plan to your specific needs and concerns. During your first visit, you will also meet with specially trained cancer nurses, cancer dietitians, counselors and physical therapists.
Support services. Our “HIPEC Buddy” program gives you the opportunity with talk to another patient who has previously undergone the HIPEC procedure. Your buddy is available to answer your questions about HIPEC, help you understand what to expect and talk through your concerns. Our team will also help you address your personal, financial and family issues through the many support services available in our Jeffrey C. Siegel Quality of Life Center.
Cancer and nutrition. Cancer and its treatment can affect the body’s ability to heal, to absorb nutrients, tolerate specific foods and maintain a healthy weight. A registered dietitian meets with patients before and after surgery to evaluate their nutritional status and develop a long-term plan to ensure that calorie and protein needs are met. This is an important step in laying the groundwork for optimal recovery. After surgery, nutritional needs will change and some patients need special nutritional support and instruction. Our registered dietitians can also help patients manage side effects and provide guidance on appropriate and helpful supplements such as vitamins and minerals.
“Prehab to Rehab.” Preparation for a successful recovery begins before surgery. HIPEC team therapists will begin by assessing your functional abilities. They will then work with you to create a home exercise program to build your upper body, lower body and core strength. Exercise plans typically include a walking or biking program to increase endurance. You will also work with a specialized cancer dietitian to help ensure you go into surgery with a strong nutritional foundation and peak immune system function.
Recovery and return home. After surgery you will be cared for by nurses and others with special training in the needs of HIPEC recovery patients. Advanced practice providers, occupational therapists, dietitians, and others will help you achieve a strong recovery and an early return to normal life. At home, you and your family will have immediate phone access to an oncology nurse to address any issues that arise. An occupational therapist will re-assess your functional ability and adjust your exercise program as needed. In addition to scheduled follow-up appointments, you will have regular contact with your care team via phone, e-mail and MyChart.
For patients traveling from a distance. Many people, including international patients travel long distances to seek HIPEC treatment at Froedtert Hospital. We are located just 30 minutes from Milwaukee’s General Mitchell International Airport and are about 90 miles north of Chicago and O’Hare International Airport with convenient proximity to major highways, nearby hotels and other amenities for travelers. Learn more about services at the hospital and nearby community.
No matter where patients live, our HIPEC team’s goal is to make your time with us and your return home a positive experience. We’re happy to collaborate with a patient’s own physician to transition care and make sure recovery and ongoing treatment needs are well-coordinated.
HIPEC Surgeons and Program Staff
HIPEC is an advanced therapy that requires strong multidisciplinary care. Our team members work together to provide fully personalized care plans and support services to ensure a good care experience and the best medical outcome.
Our HIPEC team is led by surgical oncologists who are national leaders in HIPEC treatment and research. The HIPEC team also includes medical oncologists, radiation oncologists, dedicated nurses, advanced practice providers, cancer dietitians, physical therapists, occupational therapists, care coordinators, specially trained surgery staff and other specially trained providers.
T. Clark Gamblin, MD, MS, MBA
Anai N. Kothari, MD, MS
Ugwuji Maduekwe, MD, MMSc, MPH, FACS
Dave Lal, MD, MPH (Pediatrics)
Ben George, MD
James P. Thomas, MD, PhD
HIPEC Advanced Practice Providers
Lisa Graber, APNP
Jennifer Merrill, NP
Tanya Radke, APNP
HIPEC Dietitian and Integrative Dietary Counselor
Julia Thompson, MS, RD, CD, CNSC
HIPEC Physical Therapist
Chris Walczak, PT
Kirk Ludwig, MD, FACS, FACRS
Carrie Peterson, MD
Timothy Ridolfi, MD
William Bradley, MD, FACOG
Denise Uyar, MD, FACOG
Erin Bishop, MD, FACOG
Janet Rader, MD, FACOG
Saryn Doucette, MD
James Miller, MD
Beth Erickson, MD
William Hall, MD
Charles Marn, MD
Naveen Kulkarni, MD
Stacey O'Connor, MD, MPH, MMSc
Vascular and Interventional Radiology
Sarah White, MD, MS
Eric Hohenwalter, MD, FSIR
Parag Patel, MD, MS
Robert Hieb, MD, RVT, FSIR
William Rilling, MD, FSIR
Our specialists are involved in clinical trials for many different types of cancer, including cancers that may be treated by HIPEC, offering eligible patients access to new treatment concepts.