This is a combined treatment for peritoneal carcinomatosis: first cytoreductive surgery (CRS) — complete removal of visible disease — then HIPEC, infusion of heated chemotherapy into the abdomen. It is for selected patients and is decided at a tumour board.
What is CRS/HIPEC?
It is a specialist two-part operation: cytoreduction surgically removes all visible disease from the peritoneum, and HIPEC washes the abdomen with heated chemotherapy to address microscopic residual disease.
When is it needed?
It is for selected patients with peritoneal spread from tumours such as pseudomyxoma peritonei, mesothelioma, or limited disease from colorectal/appendiceal/ovarian cancer. Decisive is the feasibility of complete cytoreduction.
Preparation
A thorough staging (CT/MRI, markers, often diagnostic laparoscopy) and assessment of the disease extent (PCI) are required. Suitability and strategy are decided at a specialist oncology centre.
How it's done
First, all visible disease is systematically removed (peritonectomies, organ resections where needed) aiming for complete cytoreduction. Then HIPEC follows: a heated chemotherapy solution is circulated in the abdomen for a set time.
Cytoreduction (CRS)
Systematic surgical removal of all visible peritoneal disease — the completeness determines the outcome.
HIPEC
Infusion of heated chemotherapy into the abdomen for microscopic residual disease, right after cytoreduction.
Tumour board
Patient selection and strategy are decided multidisciplinarily, at a specialist centre.
Recovery
This is a major operation with a prolonged hospital stay and close post-operative monitoring, often initially in a high-dependency unit. Recovery is gradual and individualised.
Risks & outcomes
It is a complex operation with a higher risk profile, which is why it is performed only at specialist centres and in carefully selected patients. In them, it can offer substantial oncological benefit. Complications relate to the extent of the cytoreduction.
Frequently asked questions
Which patients is it for?
For carefully selected patients with limited peritoneal disease, where complete cytoreduction is judged feasible. The decision is always made at a tumour board.
What is PCI?
It is an index that quantifies the extent of peritoneal disease. It helps assess suitability for CRS/HIPEC and prognosis.
How long is recovery?
It is a major operation with a prolonged stay and a gradual, individualised recovery, with close monitoring.
Is it curative?
In selected patients it can offer substantial oncological benefit and, in certain conditions, long-term disease control. The outcome depends on the tumour type and the completeness of cytoreduction.