Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a specialised treatment for cancer that has spread to the lining of the abdomen. It is not suitable for everyone. The best candidates have cancer limited mainly to the abdomen, disease that can be completely removed, good overall health and a cancer type known to respond to this approach.
Cancers That May Benefit
- Pseudomyxoma peritonei
- Appendix cancers
- Colorectal cancer with limited peritoneal spread
- Ovarian cancer, especially in selected stages
- Peritoneal mesothelioma
- Selected stomach cancers in specialised centres
Key Selection Criteria
Disease limited to the abdomen
No significant spread to the lungs, bones, brain or many liver sites.
PCI score
The Peritoneal Cancer Index measures the amount of disease. Lower scores are associated with better outcomes. Acceptable limits vary by cancer type.
Complete cytoreduction possible
The surgeon must be able to remove all visible tumour. Incomplete removal reduces benefit.
Good general health
Heart, lung, kidney and liver function must be strong enough for long surgery.
Response to chemotherapy
For some cancers, response to systemic chemotherapy helps predict benefit.
Patient motivation and support
Recovery is demanding, so commitment and family support matter.
How Is Suitability Assessed?
- CT, MRI or PET-CT scans
- Tumour markers
- Diagnostic laparoscopy to directly assess spread
- Fitness tests
- Discussion at a tumour board
Who Is Usually Not Suitable?
- Widespread cancer outside the abdomen
- Very high PCI scores for certain cancers
- Extensive small bowel involvement
- Poor general health or frailty
- Cancer that is progressing rapidly despite chemotherapy
Why Experience Matters
CRS and HIPEC are complex procedures. Outcomes are better in centres with experienced surgical, anaesthesia and critical care teams.
Key Takeaways
- CRS and HIPEC are for selected patients.
- Disease must be mainly within the abdomen.
- Complete removal of visible tumour is essential.
- PCI score guides decisions.
- Experienced centres improve outcomes.
Final Thoughts
Careful selection is the key to safe and effective CRS and HIPEC. A detailed evaluation helps decide whether this treatment can offer you real benefit. For CRS and HIPEC assessment, you can consult Dr. Varadharajan, a surgical oncologist in Chennai.
