Cytoreductive Surgery & HIPEC for Peritoneal Cancer
Advanced treatment for peritoneal surface malignancies — combining meticulous cytoreductive surgery with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) to deliver curative intent care for selected patients, under the expertise of Dr. Abhishek Aggarwal.
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Understanding Peritoneal Cancer & HIPEC
The peritoneum is the thin membrane that lines the abdominal cavity and covers its organs. When cancer cells spread to or arise within this lining, the condition is called peritoneal carcinomatosis or peritoneal surface malignancy. Historically, peritoneal spread was considered incurable and treated only palliatively. Over the last two decades, a breakthrough combination of Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) has transformed outcomes for selected patients — turning a once-terminal diagnosis into a potentially curative one.
CRS-HIPEC is one of the most complex operations in cancer surgery and should be performed only in high-volume, specialised centres with dedicated multidisciplinary teams experienced in the nuances of peritoneal oncology.
Conditions Treated with CRS-HIPEC
Pseudomyxoma Peritonei
A rare condition producing mucinous deposits throughout the abdomen. CRS-HIPEC is the gold standard treatment with excellent long-term survival.
Peritoneal Mesothelioma
A primary cancer of the peritoneum. CRS-HIPEC offers the best outcomes compared to chemotherapy alone.
Colorectal Peritoneal Spread
Selected patients with limited peritoneal metastases from colorectal cancer benefit significantly from CRS with or without HIPEC.
Ovarian & Gastric
CRS-HIPEC is increasingly used in advanced ovarian cancer and carefully selected gastric cancer patients with limited peritoneal disease.
How CRS-HIPEC Works
The procedure has two inseparable parts. First, cytoreductive surgery is performed to remove all visible tumour deposits throughout the abdomen — this often involves stripping the peritoneum, removing involved organs or segments, and meticulously clearing every surface affected by disease. This phase can last 6–12 hours. Second, once no visible tumour remains, heated chemotherapy (41–43°C) is circulated through the abdominal cavity for 60–90 minutes. The heat enhances drug penetration and cytotoxic effect, targeting the microscopic cancer cells that surgery cannot see.
Symptoms of Peritoneal Disease
Symptoms are often non-specific and include progressive abdominal distension, ascites (fluid accumulation), early satiety, unexplained weight loss, abdominal or pelvic discomfort, change in bowel habits, nausea and vomiting, and fatigue. Many patients are diagnosed late because early peritoneal spread causes few symptoms, highlighting the importance of careful surveillance in patients with primary cancers known to spread to the peritoneum.
Diagnosis & Staging
Evaluation includes contrast-enhanced CT of chest, abdomen and pelvis, MRI for peritoneal mapping, and PET-CT to rule out extra-abdominal disease. Tumour markers (CA 125, CA 19-9, CEA) guide assessment. The Peritoneal Cancer Index (PCI) is used to score disease burden — patients with a lower PCI and good performance status have the best outcomes from CRS-HIPEC. Diagnostic laparoscopy is often essential to accurately assess the extent of peritoneal disease before committing to a major operation.
Treatment Approach
Cytoreductive Surgery
Complete removal of all visible disease through meticulous peritonectomy, organ resection and careful clearance of all involved surfaces.
HIPEC
Heated chemotherapy circulated through the abdomen at the end of surgery to eradicate microscopic residual disease that cannot be removed surgically.
Systemic Chemotherapy
Pre- or post-operative chemotherapy is often combined with CRS-HIPEC to improve overall disease control and outcomes.
PIPAC
Pressurized Intraperitoneal Aerosol Chemotherapy is an emerging minimally invasive option for patients who are not candidates for full CRS-HIPEC.
Multidisciplinary Planning
Every patient is evaluated by surgical, medical and radiation oncology to ensure the best individualised plan.
Enhanced Recovery
Dedicated ERAS protocols and critical care support are essential to minimise complications and accelerate recovery from this complex surgery.
Recovery & Follow-up
CRS-HIPEC is a major operation, and recovery requires careful critical care management. Hospital stay is typically 10–15 days, and full recovery takes 2–3 months. Enhanced recovery pathways, nutritional support and close monitoring reduce complications and improve outcomes. Long-term follow-up includes clinical review, tumour markers and imaging every 3–4 months for the first two years, then every 6 months.
Why Choose Dr. Abhishek Aggarwal
Dr. Abhishek Aggarwal has dedicated training and experience in peritoneal surface oncology, including complex cytoreductive surgery and HIPEC. His multidisciplinary, patient-centred approach ensures that each patient receives a carefully individualised treatment plan based on global evidence and delivered with the highest standards of surgical care.
Frequently Asked Questions
What is HIPEC?
HIPEC stands for Hyperthermic Intraperitoneal Chemotherapy — heated chemotherapy circulated directly in the abdominal cavity after surgical removal of all visible tumour, to destroy residual microscopic disease.
Who is a candidate for CRS-HIPEC?
Patients with peritoneal disease from pseudomyxoma, mesothelioma, selected colorectal, ovarian or gastric cancers, with limited disease burden, good performance status and no extra-abdominal spread.
How long does the surgery take?
CRS-HIPEC typically takes 8–12 hours depending on disease burden, followed by 60–90 minutes of HIPEC perfusion.
Is CRS-HIPEC curative?
In conditions like pseudomyxoma peritonei and selected cases of peritoneal mesothelioma or colorectal peritoneal disease, CRS-HIPEC can offer long-term survival and, in some cases, cure.
How long is hospital stay?
Typically 10–15 days, depending on extent of surgery and recovery. Critical care support is usually required for the first few days.
What are the risks?
As a major operation, CRS-HIPEC carries risks including bleeding, infection, anastomotic leak and complications from chemotherapy. In experienced centres, morbidity and mortality rates are acceptable and comparable to other major oncological surgery.
Do I need systemic chemotherapy too?
Most patients receive systemic chemotherapy before, after or both, depending on the primary cancer type and tumour biology. The plan is individualised through multidisciplinary discussion.
What is PIPAC?
PIPAC is a minimally invasive technique that delivers aerosolized chemotherapy into the abdomen under pressure through laparoscopy. It is an option for patients who are not candidates for full CRS-HIPEC.
How is peritoneal disease diagnosed?
Through imaging (CT, MRI, PET-CT), tumour markers and often diagnostic laparoscopy to assess the Peritoneal Cancer Index and determine resectability.
How often is follow-up needed?
Every 3–4 months for the first two years with imaging and tumour markers, then every 6 months thereafter, with prompt evaluation for any new symptoms.
Meet Dr. Abhishek Aggarwal
Dr. Abhishek Aggarwal is a highly skilled GI & HPB surgeon with over 10 years of experience in managing complex gastrointestinal and hepato-pancreato-biliary diseases, with a special focus on oncological surgery. He currently serves as Associate Director – GI Oncosurgery at BLK-Max Super Speciality Hospital, where he is actively involved in delivering advanced surgical care for GI and HPB malignancies.
He has trained and worked in reputed high-volume centres, gaining extensive expertise in complex oncological procedures and multidisciplinary cancer care. His clinical practice is firmly grounded in scientific, evidence-based medicine, ensuring that patients receive treatment aligned with the latest global standards and research.
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