In some cancer types showing spread to the region of the peritoneum, treatment planning requires a multifaceted assessment process. One of the surgical approaches that may come into consideration in this process is the joint addressing of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, by its common name HIPEC. This approach, which has increasingly found a place in the surgical oncology literature in recent years, is among the options evaluated within the framework of scientific guidelines in suitable patient groups.<\/p>\n
The peritoneum is a thin membrane layer covering the abdominal cavity and the organs within it. In some cancer types, tumour cells can reach this membrane and settle on it; this situation is defined in the medical literature as peritoneal carcinomatosis or peritoneal spread.<\/p>\n
Peritoneal spread can be seen in diagnoses such as colorectal cancer, stomach cancer, ovarian cancer, tumours of appendiceal origin and pseudomyxoma peritonei. The presence of this picture requires additional assessments to be made in treatment planning. The level and extent of the peritoneal involvement of the disease are among the guiding data in determining the treatment options.<\/p>\n
Cytoreductive surgery is a surgical oncology approach that aims to reduce as much as possible, by surgical means, the visible tumour burden on the peritoneal surface or in the intra-abdominal organs. During this procedure, the affected parts of the peritoneum, the organ surfaces in contact with the tumour or other structures deemed necessary in this process can be taken into surgical assessment.<\/p>\n
The success of the cytoreduction, that is, the amount of tumour remaining after the operation, is an important clinical parameter affecting how this approach is evaluated together with its subsequent stages. For this reason, cytoreductive surgery is defined as a planned and systematic surgical process that requires a detailed preliminary assessment.<\/p>\n
HIPEC is the abbreviation of the expression hyperthermic intraperitoneal chemotherapy. Following cytoreductive surgery, it is based on the principle of circulating a heated chemotherapy solution within the abdominal cavity for a certain period. This application is carried out in the operating theatre, as a continuation of the operation.<\/p>\n
There are two fundamental reasons behind the use of a heated chemotherapy solution. The first is the scientific observations that hyperthermia may affect tumour cells through a different biological basis compared to systemic chemotherapy applications. The second is that this route allows the chemotherapeutic agents to reach the peritoneal surface directly. The transition to the systemic circulation remaining relatively limited is among the topics that form the biological rationale of this approach.<\/p>\n
The chemotherapeutic agent and concentration used in the HIPEC application are determined individually for each patient. Which drug is applied, at what dose and for how long is evaluated in line with the type of tumour, the patient’s clinical characteristics and scientific data.<\/p>\n
The combination of cytoreductive surgery and HIPEC does not automatically come into consideration in every peritoneal spread picture or every cancer type. For this approach to be taken within the scope of assessment, a series of clinical conditions need to be addressed together.<\/p>\n
In general, patients in whom the peritoneal spread remains at a limited level and complete or high-level cytoreduction is anticipated to be possible can be within the scope of assessment of this approach. In addition, the patient’s general performance status, additional diseases and previous treatment process are also among the determining elements.<\/p>\n
The peritoneal cancer index (PCI) is one of the parameters frequently resorted to in this assessment process. This measurement, which expresses the tumour burden in the different regions of the abdominal cavity numerically, is among the clinical tools used in developing a prediction regarding the applicability of surgery. However, this assessment is interpreted holistically together with the imaging findings and clinical data.<\/p>\n