HIPEC: Hyperthermic Intraperitoneal Chemotherapy

Hyperthermic intraperitoneal chemotherapy, or HIPEC, allows physicians to circulate very high concentrations of chemotherapy throughout the abdominal cavity with minimal to no exposure to the rest of the body.


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.


Anai Kothari, MD, Ugwuji Maduekwe, MD, and Callisia Clarke, MD, surgical oncologists, explain heated intraperitoneal chemotherapy (HIPEC) in the video FAQ below.

What is HIPEC surgery?

HIPEC actually is a part of a typical surgical procedure that we offer for patients with advanced peritoneal-based disease, and it stands for heated intraperitoneal chemotherapy which basically describes what is happening during that portion of the operation. We will start by doing a major part of the procedure and then follow that up by infusing or perfusing a heated chemotherapy directly into the abdominal cavity. The goal of that is twofold. One, to help actually treat the tumor directly, and then also ensure that we're able to get adequate treatment directly at the peritoneal lining within the abdomen.

What diagnoses does HIPEC treat?

HIPEC is used in patients with advanced peritoneal disease or carcinomatosis. And that can be from several different causes of cancer and typically it's started in one place and has now spread to the peritoneal lining. Some of the most common things that it comes from is the appendix, the colon or the rectum, the ovaries or mesothelioma. There's a few other disease sites that actually can cause peritoneal involvement. Those are slightly more rare, but anytime we see a patient that has peritoneal involvement of the lining of their abdominal cavity with cancer, we think of HIPEC as one of the options for them.

What are the three phases of HIPEC surgery?

I usually break HIPEC surgery down into three phases. The first is cytoreduction and that really is focused on eliminating the tumor from within the abdominal cavity. There's a lot of procedures that may go into doing that, and that includes removing a portion of the bowel, potentially other organs - like the spleen or the gallbladder. So really, that first portion, the goal is to eradicate or remove all the tumor that we can visibly see.

The next portion is actually the heated chemotherapy portion and, again, that's really meant to directly put chemotherapy on the target organ so that we're directly treating the tumor where it actually is.

And then the last portion of the operation is you know, since the first part is taking out potential organs or structures, is restoring continuity or putting everything back together. It's an important part from a quality of life and long-term standpoint to do that part well, and so we focus a lot of time and energy on ensuring that is kind of the third part of the operation.

After the surgery, the recovery is an inpatient recovery. On average patients will stay in the hospital between 7 and 10 days. A lot of that is actually dependent on, not the chemotherapy itself, but what was necessary during the operation to clear the tumor. The chemotherapy, of course, adds some additional recovery time on top of just recovering from surgery itself. I usually advise patients that the short-term recovery takes about 6 weeks overall and sometimes the ramifications, the effects of the surgery, can last even longer than that. But the key is that this is part of a multidisciplinary approach to treating this cancer.

How would you describe outcomes for HIPEC?

Peritoneal surface malignancies are an interesting and varied group of disease processes. The way I think about the outcomes for HIPEC treatment is "Why are we doing the HIPEC treatment?" And I think for anyone who has a cancer that we're taking care of, our goals are ideally to prolong the length of life, but also to treat the disease and to improve symptoms.

How does HIPEC surgery benefit patients?

HIPEC is a really important part of the treatment paradigm or how we treat patients with a multidisciplinary approach for several different diseases. You know I emphasize that really when we think about treating patients with this advanced type of tumor, we have to think about not just the surgery itself, but kind of the medical treatment before and after. Sometimes that's in combination with things like radiotherapy or immunotherapy.

HIPEC is one part of kind of the larger focus of treatment for this disease. Where it's especially beneficial is that you know what we're offering is treatment that's directly at that site of disease, so the peritoneal cavity within the abdomen directly. And what that has an advantage over some of the other treatment modalities for this type of disease is that it's a directed therapy at the tumor at the site and so there's of course advantages to that over other therapies.

What clinical team members are part of the Froedtert & MCW HIPEC team?

We take a holistic approach to our patients with peritoneal surface malignancies here. And so from that stance, we think that the HIPEC team is not just people involved directly in giving the HIPEC, but everyone involved in managing these diseases to make sure that you have the best outcome. With that approach, I believe the HIPEC team includes our group of surgical oncologists, medical oncologists, radiation oncologists, our nutritionists, clinical psychologists, physical and medical rehabilitation team all working together to make sure patients get the best outcomes which results in improved life and improved quality of life.

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 are benefits of receiving HIPEC at the Froedtert & MCW Cancer Network?

We have decades of experience taking care of patients with peritoneal surface malignancies and implementing HIPEC as one of the elements of the treatment of those patients. One of the benefits that has accrued to us taking care of these patients is not only are they exposed to everyone across the institution being used to the care of these patients from the nurses to the radiologists to the nutritionists. We also have a very longstanding and expert multidisciplinary tumor board at which every patient we see here who has a peritoneal surface malignancy and is eligible for HIPEC treatment is seen and evaluated, so not only do all those team members interact with patients but they're all we sit down and discuss their entire plan and review their pathology with everyone. That is one of the benefits of of receiving care at an institution like this.

Overview Benefits & Outcomes Who is a Candidate? What to Expect Doctors & Staff

HIPEC Procedure Uses Cytoreductive Surgery and Chemotherapy

In the HIPEC procedure, physicians deliver a high dose of heated chemotherapy directly into the abdomen. This innovative treatment strategy controls cancer while causing fewer side effects than conventional chemotherapy. 

“Intraperitoneal” means within the peritoneum, which is a membrane that lines the abdominal cavity. There are two parts to the HIPEC procedure: 

30 Pound Tumor News Item image

A Delavan woman was shocked to learn she had 30 pounds of tumors growing in her stomach from a rare type of appendix cancer. Her cancer team performed a HIPEC procedure to the abdomen. Now, six months later, the patient is cancer free and spreading the word about the outstanding care she received. Watch her story >>

  1. 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). 
  2. Chemoperfusion
    • 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 102 degrees Fahrenheit, which increases the anti-cancer effect. This part of the procedure was sometimes referred to as a "hot chemotherapy," “hot chemo bath” or "chemo wash."
    • 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 Resources