Guide to Surgery in Latin America

the Hidden Gem series

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy


I’ve been wanting to write more on this topic since I initially discussed it with Dr. Fernando Arias, MD but first, I had to educate myself more on the topic, before I could present it here. After some additional reading, and lots of additional questions for Dr. Arias – here we go…

When I first heard about this treatment being offered here in Bogota – I knew I had to tell you all about it: since this treatment is used to treat patients that are otherwise out of options.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) is used to treat patients with advanced abdominal cancers such as digestive or gynecological cancers that have spread inside the peritoneum (abdominal cavity). In many cases, these patients would otherwise receive either standard chemotherapy (not very effective) or palliative treatment only at this point – and had a very dismal** prognosis.
Now obviously, this isn’t some sort of miracle cure for everybody, and it isn’t easy, or complication-free – in fact, it is an intensive, radical approach with serious side effects, and potentially lethal complications
but it is a chance to try and aggressively pursue treatment for patients who would otherwise have little or no hope.

Some of the long term data have been very encouraging, showing significant five year survival benefits, but some of the reseach doesn’t. Some of the long term data is marred by changing techniques, administration and chemotherapy dosing.. A lot of the research, such as the Dutch trial showing 8 year follow up is plagued by small sample sizes, which limits our ability to draw strong conclusions about therapy. However, in a few of the articles I reviewed, the “c” word (Cure) was used selectively.

This treatment has been around for about ten years, but it isn’t widely available. It’s only offered at about 14 centers in the USA, a few in Europe and three in Latin America (one being here in Bogota).

So what is it? HIPEC or the short hand for this complex mouthful is surgery (laparoscopic surgery here in Bogota) to remove all visible of cancer tissue, while infusing HOT (hyperthermic) chenotherapy to kill all the cancer cells that are microscopic or not visible to the naked eye in surgery. The advantage of instilling chemotherapy right into the abdomen is that treatment is directed at the site of the disease. The warm solution promotes more effectively killing of cancer cells, and by combining surgery with chemotherapy, doctors are able to treat more advanced cancers with more effective treatment modalities (in cancer-speak: being able to surgically remove cancer is always more effective that treating it with drugs, but with standard treatments doctors could only treat limited disease (disease that had not spread). It sounds pretty simple, but it’s actually a fairly complex, drawn out process that takes multiple, multiple hours in the operating room and requires patients to be hospitalized for at least a week.

So far, Dr. Arias, and the oncologist he works with (sorry, I am blanking on the spelling of his name) started a program to offer this treatment in Bogota in 2009. Since then, they have performed over 30 cases (which if you look at the research, you’ll see is actually a fairly large number) since then.

** ‘dismal’ and ‘very dismal’ is not my editorializing; this language was used in several of the articles I read.

I’ve included some references for more information on this treatment for my readers, at the bottom of the page.

Additional References: (links to original research articles)

1. If you are only going to read one article; read this french one (in english) called:Hyperthermic Intraperitoneal Chemotherapy in Advanced
Gastric Cancer: The End of Skepticism?
It gives a good overview of WHO benefits from this treatment in regards to patients with gastric cancers.

2. Ten year’s experience of Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy – San Guiseppe Hospital, Italy

3. Hyperthermic Intraperitoneal Chemotherapy – this is a technical article that explains the rationale of treatment, and the actual methods of treatment with discussion for other medical personnel.

4. A very small Dutch trial with 8 year outcomes

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