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CRS and HIPEC Surgery

CRS and HIPEC Surgery: Benefits, Risks & Recovery

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CRS and HIPEC Surgery

Benefits, Risks & Recovery

Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) are treatments for some types of stomach and abdominal cancer. CRS removes as much cancer as possible from the belly, while HIPEC uses heated medicine inside the belly to kill any leftover cancer cells. This treatment can help some patients live longer and lower the chances of cancer coming back. In this blog, we will explain how CRS and HIPEC work, who may need them, and what to expect during treatment.

What is CRS and HIPEC Surgery?

  • Understanding CRS (Cytoreductive Surgery)
Cytoreductive Surgery (CRS) is a type of surgery that removes as much cancer as possible from the belly area. Doctors take out visible tumors, including those on organs like the intestines, stomach, or liver lining. The goal is to leave behind no visible cancer cells.
  • What is HIPEC (Hyperthermic Intraperitoneal Chemotherapy)?
HIPEC is a special chemotherapy treatment given after CRS. Instead of using regular chemo that spreads through the whole body, HIPEC is heated and put directly into the belly. The heat helps the medicine work better and kill any tiny cancer cells left after surgery. Since it stays in the belly, it has fewer side effects than regular chemotherapy.
  • How CRS and HIPEC Work Together to Treat Cancer
Doctors often use CRS and HIPEC together. First, they remove all visible cancer through surgery (CRS). Then, they apply heated chemotherapy (HIPEC) to kill any remaining cancer cells. This method lowers the chances of cancer coming back and helps patients live longer.

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Who Needs CRS and HIPEC Surgery?

This treatment is for people whose cancer has spread inside the belly area. It works best for:
Peritoneal_carcinomatosis

Peritoneal carcinomatosis

Cancer that has spread to the lining of the belly from other areas.
Ovarian_cancer

Ovarian cancer

Some ovarian cancers move into the belly and can be treated with CRS and HIPEC.
Colorectal_cancer

Colorectal cancer

When colon or rectal cancer spreads to the belly lining, CRS and HIPEC can help.
appendix_cancer

Appendix cancer

A rare type of appendix cancer that creates a jelly-like substance in the belly, which CRS and HIPEC can remove.
Mesothelioma

Mesothelioma

A rare cancer of the belly lining that can be treated with CRS and HIPEC.

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CRS and HIPEC Procedure: Step-by-Step Process

  • Preoperative Assessment and Eligibility Criteria

Before getting CRS and HIPEC, doctors check if the patient is healthy enough for surgery. They use tests like CT scans, MRIs, and blood work to see how much the cancer has spread. The main goal is to make sure the cancer is only in the belly area and that the patient can handle a big surgery.

  • Cytoreductive Surgery: Removing Visible Tumors

The first step is cytoreductive surgery (CRS). The doctor removes as much cancer as possible from the belly lining and nearby organs. Sometimes, parts of organs like the intestines, spleen, or liver must be taken out to remove all visible cancer.

  • Heated Chemotherapy (HIPEC) Application: How It Works

After CRS, the doctor applies heated chemotherapy (HIPEC) inside the belly. The chemotherapy is warmed to about 107°F (42°C) and moved around inside the belly for 60-90 minutes. 

CRS and HIPEC Procedure
  • Post-Surgery Recovery in the Hospital

After surgery, patients stay in the intensive care unit (ICU) for close monitoring. Most people stay in the hospital for 1-2 weeks. During this time, doctors help manage pain, provide nutrition, and guide patients through physical therapy. Full recovery can take a few months.

  • Eligible Cancers for CRS and HIPEC Treatment

CRS (Cytoreductive Surgery) and HIPEC (Hyperthermic Intraperitoneal Chemotherapy) are advanced treatments for peritoneal cancers. The table below outlines the key cancers and conditions where CRS and HIPEC are considered effective.

  • Swipe right to view the full table
CRS + HIPEC Cancer Table
Cancer Type/Condition Description Suitability for CRS + HIPEC
Peritoneal Carcinomatosis (from Colorectal Cancer) Cancer spread within the abdominal lining from colorectal origin. Highly effective if complete cytoreduction is achieved.
Peritoneal Mesothelioma Rare cancer of the peritoneum, often caused by asbestos exposure. Best treatment option for long-term survival.
Ovarian Cancer (Advanced/Recurrent) Cancer originating in the ovaries and spreading to the peritoneum. Used in select cases to improve survival.
Gastric Cancer with Peritoneal Spread Stomach cancer that has metastasized to the peritoneum. Used in carefully selected patients, with variable success.
Pseudomyxoma Peritonei (PMP) A rare condition where mucin-producing tumors spread in the abdomen. Best treatment available, with excellent long-term outcomes.
Appendix Cancer with Peritoneal Metastasis Cancer arising from the appendix that spreads into the peritoneum. Standard-of-care treatment for long-term disease control.

Benefits of CRS and HIPEC Surgery

Better survival rates for belly cancers

Better_survival_rates_for_belly_cancers
This treatment helps patients live longer compared to other treatments.

Improved quality of life

Improved_quality_of_life
Since the cancer is removed and treated directly, many patients feel better after recovery.

Fewer side effects

Pain Relief and Comfort Care
HIPEC stays in the belly, so it doesn’t affect the whole body like regular chemo does.

Lower risk of cancer coming back

Lower_risk_of_cancer_coming_back
This treatment helps prevent cancer from growing again in the belly.

Risks and Side Effects of CRS and HIPEC Surgery

⦿ Possible complications – Surgery may lead to infections, bleeding, or blocked intestines.
⦿ Side effects of heated chemotherapy – Some patients may feel sick, tired, or have belly pain after HIPEC.
⦿ Long hospital stay and slow healing – Patients may take weeks or months to fully recover.
⦿ Surgery risks – Like any big surgery, there are risks from anesthesia, blood clots, and damage to nearby organs.

Risks and Side Effects of CRS and HIPEC Surgery

Recovery After CRS and HIPEC Surgery

  • Hospital Stay Duration and Post-Operative Care
After CRS and HIPEC surgery, most patients stay in the hospital for 1-2 weeks. Right after surgery, they are watched closely in the intensive care unit (ICU) to make sure there are no problems. Doctors check their heart rate, breathing, and other important signs. Pain is managed with medicine, and patients get fluids and nutrition through an IV until they can eat normally.
  • Diet and Nutrition Recommendations
Eating the right foods helps the body heal. At first, patients start with a liquid diet and slowly add soft foods. Eating protein-rich foods helps rebuild strength, and drinking plenty of water prevents dehydration. A nutritionist may help plan meals that are easy to digest and full of nutrients.
  • Physical Therapy and Rehabilitation
After surgery, patients may feel weak, but moving around helps them get better. Simple exercises like short walks can prevent blood clots and help the body recover. Over time, patients can do more activities, but they should follow their doctor’s advice on what is safe.
  • Managing Post-Surgery Pain and Fatigue
Pain is common after CRS and HIPEC, but doctors give medicine to help. Feeling very tired (fatigue) can last for weeks or months. Resting is important, but light movement can also help speed up recovery. Taking things one step at a time is the best way to heal.

Success Rate and Survival Outcomes

  • Success Rates Based on Cancer Type
CRS and HIPEC work better for some cancers than others. Appendix cancer (pseudomyxoma peritonei) has high survival rates with this treatment. Colorectal and ovarian cancers that have spread to the belly can also be treated with CRS and HIPEC, improving survival chances compared to chemotherapy alone.
  • Factors Affecting Long-Term Survival
Several things affect survival rates, including:
⦿ How much cancer is removed during surgery
⦿ The patient’s overall health and age
⦿ How well the body responds to heated chemotherapy
⦿ If the cancer has spread beyond the belly lining
  • How Early Detection Improves Prognosis
Finding cancer early makes a big difference. If the cancer is removed before it spreads too much, CRS and HIPEC work better. Regular check-ups and screenings help catch cancer early, improving the chances of survival.

Alternative Treatments for Peritoneal Cancer

  • Standard Chemotherapy vs. HIPEC
Standard chemotherapy spreads through the whole body, while HIPEC targets cancer cells in the belly. HIPEC is usually more effective for peritoneal cancers, but some patients may need both treatments before or after surgery.
  • Immunotherapy and Targeted Therapy
Immunotherapy helps the immune system fight cancer, while targeted therapy attacks cancer cells in a specific way. These treatments are still being studied for peritoneal cancer but may help some patients.
  • Palliative Care for Advanced-Stage Cancer
If the cancer is too advanced for surgery, palliative care helps manage pain and symptoms. This care focuses on improving comfort and quality of life. Patients may receive pain relief, nutritional support, and emotional counseling.

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Frequently Asked Questions

What is CRS and HIPEC surgery?

CRS (Cytoreductive Surgery) removes cancer from the belly, and HIPEC (Heated Intraperitoneal Chemotherapy) uses warm medicine to kill any leftover cancer cells. This treatment is for cancers that spread inside the belly.

Who needs CRS and HIPEC surgery?

People with certain cancers, like appendix cancer, peritoneal mesothelioma, or colon cancer that has spread inside the belly, may need this surgery.

How does HIPEC work?

After removing cancer, doctors put heated chemotherapy medicine inside the belly to kill any cancer cells left behind. The heat helps the medicine work better.

Is CRS and HIPEC a major surgery?

Yes, it is a big surgery that can take 8-12 hours. Patients need a lot of care and time to heal after the procedure.

What are the risks of CRS and HIPEC?

Like other big surgeries, risks include infection, bleeding, digestion problems, and slow healing. Doctors check if a patient is strong enough before doing the surgery.

How long does recovery take?

Most patients stay in the hospital for 1-2 weeks and take a few weeks at home to recover. Eating healthy food, light walking, and regular doctor visits help in healing.

Will I need chemotherapy after CRS and HIPEC?

Some people may need more chemotherapy after surgery to stop the cancer from coming back. The need for extra treatment depends on the cancer type and stage.

Does HIPEC have side effects?

Since HIPEC is given inside the belly instead of through the veins, it has fewer side effects than regular chemotherapy. Some people may feel tired or have stomach problems.

What are the chances of success with CRS and HIPEC?

The success of the surgery depends on the cancer type and stage. In many cases, it helps people live longer and feel better.

Is CRS and HIPEC surgery available in India?

Yes, many top hospitals in India have expert doctors who perform CRS and HIPEC surgery with advanced medical care.
Dr Harsh Shah - Robotic Cancer Surgeon

Written by

Dr. Harsh Shah

MS, MCh (G I cancer Surgeon)

Dr. Harsh Shah is a renowned GI and HPB Robotic Cancer Surgeon in Ahmedabad.

Dr Swati Shah

Reviewed by

Dr. Swati Shah

MS, DrNB (Surgical Oncology)

Dr. Swati Shah is a Robotic Uro and Gynecological Cancer Surgeon in Ahmedabad.

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