Although the HIPEC procedure is performed with the intent to cure a patient, it should be realized that peritoneal cancer is an aggressive disease, which often recurs even after a successful HIPEC-procedure. Prognosis after HIPEC is influenced by many factors such as the origin and the extent of the disease at the time of diagnosis, the possibility to remove all visible cancer during surgery and the condition of the patient. Certainly not all patients are cured after a HIPEC-procedure but generally speaking, survival after HIPEC is expressed in years rather than in months. Cure may be achieved in select patients.
To further improve outcomes after HIPEC, the treating physician may advise additional systemic chemotherapy. Such chemotherapy, which is typically started four to six weeks after the HIPEC procedure, is administered by infusion and/or pills. The aim of the chemotherapy is to prevent or delay peritoneal recurrence and metastatic spread to other organs, such as the liver or lungs. The medical term for chemotherapy in this situation is “adjuvant chemotherapy”.
Chemotherapy is not beneficial for every patient following HIPEC, and the decision to pursue chemotherapy depends on many factors that should be considered in every individual patient.
Patients may encounter specific problems and may have questions years after HIPEC. Therefore, close follow-up by a physician with knowledge of peritoneal cancer and HIPEC is highly desirable during this period. The results after HIPEC in terms of survival-benefit vary widely among patients. For example, results depend on origin of the peritoneal cancer and the extent of the disease at the time of diagnosis.
In general, prognosis of patients with pseudomyxoma peritonei in whom complete removal of the tumor can be achieved is good after HIPEC and the majority of such patients may even be cured. HIPEC reduces recurrence rates in ovarian cancer. Cure is less often achieved in colorectal cancer patients and those with malignant mesothelioma but generally speaking, survival after HIPEC in these patients is expressed in years rather than in months as used to be the case with other treatments.
Since HIPEC is a complex and invasive procedure, postoperative complications occur frequently. Relatively frequent complications include an infection of the lungs or urinary bladder, wound problems and the inability to eat or drink during several days or even weeks. A less frequent but more serious complication is leakage of bowel contents into the abdomen resulting in abdominal infections. A second procedure may be needed in these patients to control the leakage.
Some patients experience side effects from the chemotherapy that is used during HIPEC but these are mostly mild and self-limiting. Significant hair loss as a result from the HIPEC-chemotherapy is very rare. Fortunately, the number of patients encountering complications has been steadily decreasing in the last few decades. Most patients are hospitalized for two to four weeks, although their stay may be longer if complications occur. During hospitalization, catheters that were installed during surgery, such as catheters in the urinary bladder, stomach or abdominal cavity, are removed.
Despite the complexity of the operation, a HIPEC procedure is now considered very safe. The chances of dying as a result of complications after treatment is less than 3% in experienced HIPEC centers. These odds compare favorably to other high-risk surgical procedures.
Several studies have investigated the quality of life (QOL) experienced by patients after a HIPEC procedure. These studies show that the QOL drops during the immediate postoperative period, which is to be expected given the impact of the procedure. However, three months after treatment, the QOL is restored to baseline levels in most patients and may even improve over the pre-operative QOL after six months. Based on these results, researchers have concluded that the QOL is generally preserved after HIPEC and may even be improved in select patients.