What Is HIPEC Surgery for Mesothelioma?

How HIPEC Works

HIPEC is a specialized technique in which chemotherapy drugs, heated to 41–43°C (106–109°F), are circulated directly through the abdominal cavity after the surgeon has completed cytoreductive surgery (CRS) to remove all visible tumor. The chemotherapy bathes all surfaces of the peritoneal cavity for 60–90 minutes, targeting any remaining microscopic cancer cells that surgery alone cannot eliminate.

Heating the chemotherapy enhances its effectiveness in two key ways. First, hyperthermia itself is toxic to cancer cells and damages their ability to repair DNA. Second, heat increases the penetration of chemotherapy drugs into tissue, allowing them to reach cancer cells up to 2–3 mm beneath the peritoneal surface. Direct intraperitoneal delivery also achieves drug concentrations 20–400 times higher than systemic intravenous chemotherapy, with significantly less whole-body toxicity.

The CRS/HIPEC Procedure

CRS/HIPEC is a lengthy procedure, typically requiring 8–14 hours in the operating room. The surgery begins with a complete exploration of the abdominal cavity to assess the extent of disease using the Peritoneal Cancer Index (PCI), a scoring system that maps tumor distribution across 13 abdominal regions. The surgeon then performs systematic cytoreduction — removing all visible tumor, which may involve peritonectomy, omentectomy, and partial organ resections as needed.

Once cytoreduction is complete, the HIPEC phase begins. Heated chemotherapy solution is pumped into the abdomen through inflow catheters and drained through outflow catheters in a continuous circuit. Temperature probes monitor the solution throughout the cavity to ensure uniform heating. The surgeon gently manipulates the solution to distribute it evenly. After the perfusion period, the solution is drained, the abdomen is irrigated, and any necessary bowel reconstructions are completed before closure.

Who Is a Candidate?

Eligibility for CRS/HIPEC depends on several factors. Ideal candidates have peritoneal mesothelioma with a PCI score suggesting disease can be completely removed, epithelioid cell type (associated with the best outcomes), adequate organ function and nutritional status, and good performance status to tolerate a major procedure. Patients with widespread extraperitoneal disease, certain unfavorable cell types, or severe comorbidities may not be appropriate candidates.

Preoperative evaluation includes CT scanning with contrast, PET-CT in some cases, blood work including tumor markers, nutritional assessment, and cardiac clearance. Diagnostic laparoscopy may be performed beforehand to assess resectability.

Recovery and Outcomes

Recovery from CRS/HIPEC is significant. Most patients spend 10–14 days in the hospital, including several days in intensive care. Complications can include anastomotic leak, wound infection, venous thromboembolism, and prolonged ileus. At experienced centers, major complication rates range from 20–40%, and perioperative mortality is 1–4%.

Despite the demanding recovery, the survival outcomes justify the approach for eligible patients. Multi-institutional data show median survival of 53 months, and select patients with complete cytoreduction and epithelioid histology have achieved median survival exceeding 7 years — outcomes that are remarkable for any form of mesothelioma.

Finding a HIPEC Center

CRS/HIPEC is performed at a limited number of specialized centers. The procedure should only be undertaken by surgical teams with extensive experience in peritoneal surface malignancies. Key centers include those at major academic cancer institutions with dedicated peritoneal mesothelioma programs. Patients should not hesitate to travel for this level of specialized care. Legal compensation from asbestos exposure can help cover treatment and travel costs. Contact us at 1-800-400-1805 for a free consultation.