HIPEC, the name of international technology, is an abbreviation which means hyperthermic Intraperitoneal Chemotherapy, which means flushing the cavity of the abdomen with heated chemotherapy. The French equivalent of HIPEC is "CHIP", which means: hyperthermic intraperitoneal chemotherapy. The surgical treatment consists of three phases: exploration, debulking and even chemotherapy.
1. exploration
The surgeon opens the abdomen by a long incision in the midline. After the release of any adhesions, it will make a careful assessment of cancer of the peritoneum. He aims to answer three questions:
1. What is the extension of cancer of the peritoneum?
To this end, the surgeon measures the amount of cancer in 13 regions of the stomach which gives it a score of 1 to 3. These scores are added up in an overall score (the Peritoneal Cancer Index Sugarbaker). This score has a dual purpose. In cases of cancer of the peritoneum by a tumor of the colon (large intestine), the score to avoid an intervention that would be unnecessary if the score is above 20. In this case, there is very little chance of achieving a HIPEC offers better patient survival, when the intervention will not be continued. The score also allows an estimate of prognosis is the lowest score, the better the prognosis.
2. Is it known to remove all households in cancer?
Especially in the case of cancer of the peritoneum by a tumor of the colon (large intestine), it is very important that all households with cancer that are visible to the naked eye can be removed prior to rinsing with chemotherapy. When we do not remove all visible outbreaks, there is very little chance of achieving a HIPEC offers better patient survival, and response will not be continued.
A primary cause of the inability to remove all households tumor is the presence of homes on a too large area of the small intestine: there must be at least 1.5 m of small intestine to allow for a healthy normal absorption of food. Then, the vessels of the liver may be surrounded by the tumor, which prevents a complete resection. Finally, part of the stomach may be covered by the tumor. Although resection of part or all of the stomach in this case is technically possible, the quality of life after this intervention as part of a HIPEC is too bad with digestion difficulties, in which HIPEC case is no longer justified.
3. Are there any seeding in the liver?
Despite all the advances in medical imaging techniques before the operation (scan, magnetic resonance, PETscan), it is not possible to exclude in advance and with certainty 100% seeding of the liver (metastases in liver). The surgeon performs the operation during an ultrasound. When we discovered sowing liver, there is very little chance of achieving a HIPEC offers better patient survival, and the intervention was not continued.
When peritoneal cancer is not too large, it can be removed completely, and no liver metastases, the surgeon begins the next phase of the intervention: the débulking (see below) . Otherwise, it makes no HIPEC, but if necessary intervention to prevent or relieve obstruction by a short circuit between the area of the intestine immediately upstream and the area of the intestine just downstream of the narrowing .
2. debulking
Cytoreduction means Debulking or removal (resection) of all tumor homes that are visible for the naked eye.
-peritoneum where it is achieved by tumor homes.
-l 'epiploon: the "fat apron" hanging from the stomach and intestines and the drape which is often the bearer of tumor.
-in each case, resection of the spleen, gall bladder, uterus (womb) and ovaries, part of the diaphragm, part of the small intestine or large intestine or other organs if necessary.
It is this part of the assistance which can last several hours, see a good part of the day.
3. rinse the belly cavity with heated chemotherapy
After removing all visible tumor, we rinse the belly cavity with heated chemotherapy. We are putting pipes in the belly cavity to transport heated liquid from fluid reservoir external to the stomach, and then repeat the liquid to the tank by a closed circuit. When the desired temperature is reached, a chemotherapy adds to the liquid. For bowel cancer, for example, should be rinsed with the mitomycin C to 41.5 ° Celsius for 90 minutes. For other tumors using other schemes.
