Advanced Cytoreductive Surgery and Hyperthermic intraperitoneal chemotherapy (HIPEC)
THE LARGEST CENTER IN INDIA AND ENTIRE ASIA AND PIPAC
Manipal comprehensive cancer centre, Manipal hospitals Bangalore, India, has an established HIPEC program since 2005 and is the number one referral centre for peritoneal cancer treatment in Asia. Has the largest number of HIPEC done in entire Asia and member of ISPSM society too The HIPEC trained super specialist surgeons and surgical oncology team of Dr. Somashekhar SP, Dr. Shabber Zaveri, and Dr. Ashwin Rajagopal are experts in performing complex abdominal surgery for peritoneal cancers and have performed over 300 surgeries. We have a highly experienced staff as well, including medical oncologists, seasoned nurses and other clinicians who are familiar with the needs of patients undergoing Cytoreductive surgery and HIPEC. This center used advanced state of art high quality approved dedicated HIPEC machine from Europe and USA (unlike other centers which did makeshift heart-lung machines, not recommended by regulatory authorities) Both HIPEC and PIPAC programme at India
Peritoneal surface malignancies are serious cancers that develop on the lining of the abdomen, called the peritoneum. They often develop when tumours from the appendix, rectum, colon, stomach, ovaries or other organs spread to peritoneal surfaces. Cytoreductive Surgery and Hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment option for these patients where extensive surgery is performed to remove all visible cancer tissue followed by chemotherapy drug, heated to 42 degrees Celsius is pumped through the abdominal cavity using a specialized HIPEC machine. This multimodality treatment considerably increases life expectancy and reduces the rate of cancer recurrence.
The surgical management of advanced ovarian, primary peritoneal, colorectal and gastric cancers has evolved from the performance of basic debulking procedures to the incorporation of more comprehensive surgical procedures. This surgery aims for the complete removal of all visible tumors affecting the protective lining of the abdomen. Cytoreduction is complex and can last for an extended period of time, only an experienced specialist can perform the procedure effectively.
During cytoreductive surgery, the surgeon uses a tool called an electrosurgical handpiece to remove tumors. It generates an intense amount of heat via high-voltage electricity and burns diseased tissue at the edges of the incision. These complex procedures involving multi-organ resections are generally long and require excellent knowledge of abdominal anatomy.
Hyperthermic intraperitoneal chemotherapy (HIPEC) is a highly concentrated, heated chemotherapy treatment that is delivered directly to the abdomen during surgery. Unlike systemic chemotherapy delivery, which circulates throughout the body, HIPEC delivers chemotherapy directly to cancer cells in the abdomen. This allows for higher doses of chemotherapy treatment. Heating the solution may also improve the absorption of chemotherapy drugs by tumors and destroy microscopic cancer cells that remain in the abdomen after surgery.
Before patients receive HIPEC treatment, doctors perform cytoreductive surgery to remove visible tumors within the abdomen. Cytoreductive surgery is accomplished using various surgical techniques. Once as many tumors as possible have been removed, the heated, sterilized chemotherapy solution is delivered to the abdomen to penetrate and destroy remaining cancer cells. The solution is 41 to 42 degrees Celsius, about the temperature of a warm bath. It’s circulated throughout the abdomen for approximately 1 ½ hour. The solution is then drained from the abdomen and the incision is closed. After the procedure, patients are required to spend an average of 2 weeks in the hospital. Nurses monitor vital signs throughout the patient’s stay and make sure that no post-surgical complications occur.
Almost all the abdominal cancers spread to peritoneal surface (a layer which covers abdominal structures). Despite numerous recent advances in chemotherapy, once cancer gets spread to these structures, it is considered “Incurable” for a long time. And the side effects of chemotherapy are difficult for the patient to endure. However, when these cancers are confined to the peritoneal cavity, Hyperthermic Intraperitoneal Chemotherapy (HIPEC) becomes an option for candidate patients. Manipal Hospital, Bangalore is the first centre in south India to provide this state of the art technology and has the credit of the largest number of HIPEC surgeries performed in India. We have FDA approved Belmont® Hyperthermia pump which perfusates chemotherapy mixed fluid into the abdominal cavity around 41-43 degree centigrade temperature over 60-90 minutes. Hyperthermia helps to kill the microscopically spread cancer cells after complete removal of visible cancer from the abdomen. Before HIPEC is administered, the surgeon will remove all visible tumours that can be removed throughout the peritoneal cavity. This is known as cytoreductive surgery. Following cytoreductive surgery, in the operative setting, the surgeon will administer HIPEC treatment.
Cancer in which HIPEC is useful
• Pseudomyxoma Peritonii
• Colorectal cancers with peritoneal spread
• Advanced ovarian cancers
• Recurrent ovarian cancer
• Stomach cancer
A thirty-eight-year-old lady from Bhubaneswar, who diagnosed with “Pseudomyxoma Peritonii” (jelly-like mucous material spread all over abdominal cavity due to ovarian cancer), was landed in Manipal comprehensive cancer centre. She has consulted many doctors all over India and no other treatment options offered to her and abdominal distension was increasing day by day. A team of doctors under Dr. Somashekhar S.P. (Chairman and HOD and Consultant Surgical Oncologist) operated upon her over 10 hours, major organ resections and reconstruction done. HIPEC was given over 90 minutes at 41.5º C. She recovered fully after the procedure and discharged home on the 9th postoperative day. She is now doing well and happily, enjoys life without trouble. Until this special facility and HIPEC machine was available in India, patients used to travel to Europe or USA and get this treatment. Most of the research results have proven HIPEC is the best treatment modality currently available for the peritoneal cancer spread. HIPEC improves drug absorption by the cancer cells and kills cancer cells effectively with minimal effect on the rest of the body. In this way, the usual side effects of chemotherapy can be avoided.
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