When ovarian cancer spreads to the lining of the abdomen — a surface called the
peritoneum — conventional chemotherapy given through a vein often struggles to reach the
cancer effectively. The peritoneal lining acts as a barrier, limiting the concentration of
cancer-killing drugs at the exact site where the disease has taken hold. For years, this made
peritoneal carcinomatosis one of the most difficult stages of ovarian cancer to treat with
lasting results.
HIPEC — short for Hyperthermic Intraperitoneal Chemotherapy — was developed
specifically to address this challenge. It is a surgical procedure that combines aggressive
cancer removal with a heated chemotherapy wash delivered directly into the abdominal
cavity during the operation itself. The results, for carefully selected patients, can be very
encouraging.
How does HIPEC Surgery Work ?
HIPEC is not a standalone chemotherapy session — it is a complex, two-part surgical
procedure. The first part is cytoreductive surgery, during which the surgeon removes every
visible tumour deposit from the peritoneal surface. This may include removing involved
peritoneum, parts of the bowel, the omentum (the fatty tissue which hangs from the stomach
and large bowel), the uterus, fallopian tubes, and ovaries, as well as the lymph nodes in
abdomen and pelvis.
Once the surgical team achieves what is called an optimal resection — meaning no visible
residual disease — the HIPEC phase begins. A heated chemotherapy solution, typically
containing cisplatin or carboplatin, is circulated through the abdominal cavity at a
temperature of 41 to 43 degrees Celsius for approximately 60 to 90 minutes.
The heat makes cancer cells more vulnerable to chemotherapy — heat disrupts the cell
membranes of tumour cells and allows a much higher concentration of the drug to reach
microscopic residual disease that the surgeon cannot see or remove with a scalpel. After the
heated wash is complete, the solution is drained and the abdomen is closed.
Why is HIPEC used for Ovarian Cancer ?
Ovarian cancer has a tendency to spread along the peritoneal surface rather than through
the bloodstream in its early metastatic stages. This makes it a particularly suitable cancer for
a treatment that delivers chemotherapy directly to that surface. In contrast to intravenous
chemotherapy, which must travel through the bloodstream and loses concentration before
reaching the peritoneum, HIPEC delivers drug concentrations at the tumour site that are 20
to 100 times higher than what is safely achievable through a vein.
Clinical studies, including the landmark Dutch OVHIPEC trial, have demonstrated that
women with Stage III ovarian cancer who received cytoreductive surgery followed by HIPEC
had significantly better recurrence-free survival and overall survival compared to those
who received surgery and intravenous chemotherapy alone. This evidence has made HIPEC
an increasingly important option at specialised cancer centres.
Given the complexity of cytoreductive surgery and HIPEC — which can take 8 to 12 hours in
the operating theatre and requires expertise in both advanced gynecologic oncology surgery
and intraoperative chemotherapy delivery — it is critical that patients seek care from a Best Gynec Oncologic Cancers Specialist in Delhi who is specifically trained in this procedure. Not every oncology centre in North India offers HIPEC, and surgical outcomes are closely
tied to the volume of cases a team handles.
Who Is a Candidate for HIPEC Surgery ?
HIPEC is not appropriate for every patient with advanced ovarian cancer. Patient selection is
one of the most important factors in achieving good outcomes. The procedure is generally
considered for:
• Women with Stage III epithelial ovarian cancer where the disease is confined to
the peritoneal surface.
• Patients whose cancer responds well to neoadjuvant chemotherapy given before
surgery.
• Those who are fit enough to tolerate a prolonged surgery lasting 8 to 12 hours.
• Women with recurrent ovarian cancer that remains limited to the abdomen after
prior treatment.
• Patients where the surgeon believes complete cytoreduction is achievable.
Women with extensive spread beyond the peritoneum, poor overall health, or where
complete removal is not surgically feasible are generally not candidates for HIPEC. The
decision requires a thorough evaluation including PET-CT imaging, tumour markers,
nutritional status, and discussion at a multidisciplinary tumour board.
What to Expect: Recovery After HIPEC
HIPEC is a major surgery and recovery takes time. Most patients spend 7 to 14 days in
hospital following the procedure. The first few days typically involve intensive monitoring in a
high-dependency or ICU setting.
Common post-operative experiences include changes in electrolytes and blood counts,
fatigue, discomfort at the surgical site, and temporary changes in bowel function as the
digestive system recovers from both the surgery and the heated intraperitoneal
chemotherapy. Most women are able to return to light activities within 6 to 8 weeks and
begin any additional adjuvant chemotherapy within 4 to 6 weeks of recovery.
For women in and around Haryana and the National Capital Region, access to HIPEC for
ovarian cancer in Faridabad means they no longer need to travel to distant cities for this
highly specialised procedure. Having a centre of expertise close to home allows families to
remain involved in care and reduces the logistical and financial burden of treatment.
HIPEC and the Road Ahead: What Comes After
Surgery ?
HIPEC is usually followed by a course of intravenous carboplatin and paclitaxel
chemotherapy to target any circulating cancer cells that may not have been reached during
the procedure. Depending on the patient's BRCA mutation status, a PARP inhibitor such
as olaparib may be recommended as maintenance therapy to prevent or delay recurrence.
Regular follow-up after Cytoreductive surgery and HIPEC is essential. This includes CA-125
monitoring every 3 months for the first two years, Ultrasound or CT or PET-CT imaging
when indicated, and pelvic examination at each visit. Any persistent symptoms — abdominal
pain, bloating, change in appetite — should be reported promptly, as early detection of
disease recurrence significantly improves the options available.
Considering HIPEC Surgery in Faridabad ?
Dr. Neha Kumar performs HIPEC Surgery in Faridabad at Amrita Hospital — one of the few
centres in North India offering this advanced procedure for ovarian cancer.
In selected cases of recurrent ovarian cancer with peritoneal spread, a second cytoreductive
surgery with HIPEC is possible and may offer benefit. This decision is made on a case-by-
case basis after thorough evaluation.