How HIPEC Improves Survival in Ovarian Cancer Patients

Understanding advanced ovarian cancer

Ovarian cancer often grows silently inside the abdomen and is frequently diagnosed in stage III or IV, when the disease has already spread over the peritoneum (the inner lining of the abdomen). Tiny seeds of cancer can sit on the bowel, liver surface, diaphragm, pelvis, and other organs, making treatment more complex than simply removing a single tumour.​

Standard care combines surgery and chemotherapy, but even after major debulking surgery and multiple chemotherapy cycles, microscopic cancer cells can stay behind inside the abdominal cavity and later cause recurrence. That “hidden residual disease” is the main reason many women see the cancer return within a few years, even after responding well initially.​

This is exactly where HIPEC—Hyperthermic Intraperitoneal Chemotherapy—adds a powerful extra layer of treatment.

What exactly is HIPEC?

HIPEC stands for Hyperthermic (heated) Intraperitoneal (inside the abdomen) Chemotherapy. It is not a separate operation but an important second phase of a specialised surgery called cytoreductive surgery (CRS).​

Dr. Vimalathithan’s workflow in an eligible ovarian cancer case typically has two major steps:

1. Cytoreductive surgery (CRS)

   • The first aim is to remove all visible tumour deposits—on ovaries, uterus, omentum, peritoneum, and any involved bowel or organ surfaces.​

   • Surgeons call this “complete cytoreduction” or CC‑0/CC‑1, which means there is no visible disease left or only deposits smaller than a few millimetres.​

2. HIPEC inside the same operation

   • After completing the surgical removal, a heated chemotherapy solution is circulated within the abdominal cavity for about 60–90 minutes at around 41–43°C.​

   • The solution continuously bathes all peritoneal surfaces before being drained out, while the patient remains under anaesthesia.​

Because the drugs are delivered directly where the microscopic cancer cells live—and at a higher temperature than the rest of the body—HIPEC can kill residual tumour cells much more effectively than intravenous chemotherapy alone.​

How does HIPEC work scientifically?

HIPEC improves outcomes through a combination of three mechanisms:

• Direct high‑dose exposure

  
  

  The chemotherapy fluid reaches much higher concentrations in the abdomen than what can safely be given through a normal IV drip, yet with relatively limited exposure to the rest of the body.​

• Heat‑enhanced cancer kill

  
  

  Cancer cells are more sensitive to temperatures around 41–43°C than normal cells. Heat itself damages tumour cell membranes and DNA and also makes them more permeable to chemotherapy drugs such as cisplatin, increasing drug uptake and effectiveness.​

• Targeting microscopic disease

  
  

  Even when scans look clear, microscopic nodules can hide in peritoneal folds and on organ surfaces. Circulating fluid reaches these unresectable or invisible cells and reduces the risk of peritoneal recurrence.​

For patients and families, the simple takeaway is that HIPEC tries to “wash out” the abdominal cavity with a heated anti‑cancer solution at the exact moment when the surgeon has removed as much visible tumour as possible.

What does the survival data show?

Over the last decade, several high‑quality studies and meta‑analyses have evaluated HIPEC for advanced epithelial ovarian cancer. Overall, they point in the same direction: when HIPEC is added to optimal cytoreductive surgery in carefully selected women, long‑term outcomes improve.​

Key findings in simple language

• A landmark randomised trial (OVHIPEC‑1) in women with stage III disease showed that adding HIPEC at interval cytoreductive surgery after neoadjuvant chemotherapy extended both recurrence‑free survival and overall survival, without increasing serious side‑effects.​

• Long‑term follow‑up from this trial, with a median follow‑up of over 10 years, confirmed that the survival benefit of HIPEC persisted over time across different patient subgroups.​

• A large NCDB analysis reported that patients who underwent cytoreductive surgery plus HIPEC had a median overall survival of 42 months compared with 34 months after surgery alone, with more women alive at 5 years in the HIPEC group.​

• A recent meta‑analysis pooling multiple trials and cohort studies found significantly better overall survival and progression‑free survival when HIPEC was combined with CRS, without a proportional rise in severe complications.​

• An Indian multicentric registry of 1,470 patients treated with CRS‑HIPEC showed 4‑year overall survival rates around 60% in primary advanced ovarian cancer, which is encouraging in a population traditionally presenting late.​

Another up‑front HIPEC study reported that women receiving CRS plus HIPEC were 67% less likely to die from any cause, 75% less likely to die from ovarian cancer, and 46% less likely to have a recurrence compared with those undergoing surgery alone.​

Taken together, these results explain why more leading oncology centres—including Indian centres—are integrating HIPEC for selected women with advanced or recurrent ovarian cancer.​

Does HIPEC affect quality of life?

Because HIPEC adds time and intensity to an already major operation, many families worry about how it will affect recovery and everyday functioning.

Reassuringly, quality‑of‑life research shows that when HIPEC is performed in experienced centres along with cytoreductive surgery:

• Overall health‑related quality of life (HRQOL) scores after recovery are similar between women who had surgery with HIPEC and those who had surgery alone.​

• Temporary dips in physical well‑being immediately after surgery are expected for both groups and generally improve over the following months.​

• At 24 months, physical, emotional, and functional scores were not worse—and in some analyses slightly better—in the HIPEC group.​

This means that for most appropriately selected patients, the improved survival does not come at the cost of long‑term quality of life. Instead, many women are able to return to family roles, work, and personal goals while living longer with better disease control.​

Which ovarian cancer patients may benefit from HIPEC?

HIPEC is not appropriate for every woman with ovarian cancer. Careful selection is essential, and this is where an experienced surgical oncologist like Dr. Vimalathithan plays a crucial role.​

Typical candidates include:

• Women with stage III or selected stage IV epithelial ovarian cancer in whom complete or near‑complete cytoreductive surgery appears achievable.​

• Patients who respond well to neoadjuvant (pre‑operative) chemotherapy and are planned for interval cytoreductive surgery.​

• Selected women with recurrent, platinum‑sensitive disease confined to the abdomen, without spread outside the peritoneal cavity.​

• Patients with good performance status, adequate heart, lung, kidney function, and no prohibitive medical comorbidities.​

Each case is discussed within a multidisciplinary tumour board that includes medical oncologists, radiation oncologists, radiologists, pathologists, and anaesthesiologists to ensure that HIPEC is being used where it genuinely adds value.​

Inside the operation – what patients and families should know

From a patient’s perspective, undergoing CRS + HIPEC with Dr. Vimalathithan usually feels like “one long operation,” but there are several carefully planned stages behind the scenes:

1. Pre‑operative preparation

   • Detailed imaging (CT/MRI/PET‑CT) evaluates how extensively the peritoneum is involved.​

   • Blood tests, cardiac and pulmonary assessments minimise anaesthesia risk.​

   • Nutritional and physiotherapy inputs help build strength before surgery.​

2. Cytoreductive surgery

   • Through a midline abdominal incision, all visible disease is systematically removed: hysterectomy, salpingo‑oophorectomy, omentectomy, peritonectomy, removal of implants on the diaphragm, bowel, liver capsule, etc., as required.​

   • The surgical team aims for no visible residual nodules, because the benefit of HIPEC is greatest when macroscopic disease has already been cleared.​

3. HIPEC perfusion

   • Inflow and outflow catheters plus temperature probes are positioned in the abdomen.​

   • A dedicated HIPEC pump warms and circulates chemotherapy—most often cisplatin‑based regimens in ovarian cancer—for approximately 60–90 minutes while the abdomen is gently agitated to ensure even distribution.​

   • Throughout, the anaesthesia team closely monitors core temperature, urine output, electrolytes, and haemodynamics.​

4. Post‑operative care

   • Patients are shifted to a high‑dependency or ICU setting for the first 24–48 hours for close observation.​

   • Pain control, early mobilisation, breathing exercises, and gradual reintroduction of oral feeds support faster recovery.​

Although the operation is longer and more complex than standard debulking, large Indian series report acceptable morbidity and low mortality when performed in specialised centres.​

Possible risks and side‑effects

Honest counselling is a hallmark of ethical cancer care. While HIPEC offers clear potential benefits, it carries risks like any major procedure. Reported complications include:

• Infection or collection inside the abdomen.​

• Temporary kidney strain, especially with cisplatin; patients are therefore well hydrated and closely monitored.​

• Electrolyte imbalances, bleeding, or anastomotic leaks after bowel resections.​

• Lung‑related issues (such as pneumonia or fluid overload) in the immediate post‑operative period.​

In the Indian multicentre registry, overall grade 3–5 morbidity was about 25%, with 30‑day mortality around 3–4%, figures comparable to other extensive oncologic surgeries when performed in experienced hands.​

Dr. Vimalathithan carefully weighs these risks against the expected survival advantage, always tailoring recommendations to the patient’s age, fitness, tumour biology, and personal priorities.​

Life after HIPEC – follow‑up and long‑term outlook

After recovering from CRS + HIPEC, most women continue with systemic chemotherapy as advised by their medical oncologist, particularly in advanced or high‑risk disease. Regular follow‑up typically includes:​

• Clinical examinations and CA‑125 monitoring at defined intervals.​

• Periodic imaging to detect recurrence early.​

• Ongoing support for nutrition, menopausal symptoms, emotional health, and sexual well‑being.​

Encouragingly, long‑term data show a subset of women living beyond 5–10 years without disease progression when HIPEC is added to optimal treatment, especially in primary advanced epithelial ovarian cancer. For many families, this transforms the conversation from “how long do we have?” to “how do we plan the next chapter of life?”.​

Why consult a specialised HIPEC surgeon like Dr. Vimalathithan in Chennai?

HIPEC is a technology‑driven, team‑intensive procedure. Outcomes depend not only on the machine but on the surgical oncologist’s judgment, technical skill, and multidisciplinary coordination.​

A specialist like Dr. Vimalathithan brings:

• Expertise in complex peritoneal surface oncology and advanced pelvic surgery, which is critical for achieving complete cytoreduction.​

• Familiarity with international HIPEC protocols, drug regimens, and patient‑selection criteria, adapted to Indian patients and resource settings.​

• Close collaboration with medical oncology, ICU, anaesthesia, and nursing teams to ensure safe peri‑operative care and evidence‑based adjuvant treatment.​

For patients in and around Chennai, this means access to a cutting‑edge modality within a human‑centred environment where each case is discussed in detail and decisions are made together with the family.

Key questions to ask during your consultation

When you meet Dr. Vimalathithan—or any HIPEC‑trained oncologist—it can help to bring a written list of questions, such as:

• Am I a suitable candidate for cytoreductive surgery with HIPEC, given my stage, spread pattern, and general health?​

• What survival improvement can I realistically expect compared with surgery alone in my specific situation?​

• What are the main risks in my case, and how does your team minimise them?​

• How long will I be in hospital, and how soon can I get back to routine activities?​

• How will this treatment integrate with chemotherapy—before and after surgery?​

Being informed helps you feel more in control and supports shared decision‑making, which is especially important in major oncologic procedures.

When to seek an opinion

You should consider consulting Dr. Vimalathithan for a HIPEC‑focused opinion if:

• You or a loved one has been newly diagnosed with stage III or IV ovarian cancer.

• Your oncologist has mentioned peritoneal metastasis or “diffuse spread inside the abdomen.”​

• You are facing recurrent ovarian cancer confined to the abdomen, particularly if it remains platinum‑sensitive.​

• You want to understand all advanced surgical options, including HIPEC, before starting or after completing initial chemotherapy.

Even if HIPEC turns out not to be the right choice, a comprehensive review of your scans, reports, and overall health can clarify the best available path forward.

For many women, adding HIPEC to cytoreductive surgery offers a meaningful chance of longer survival and better disease control in the face of a challenging diagnosis like advanced ovarian cancer. With the guidance of an experienced surgical oncologist such as Dr. Vimalathithan in Chennai, families can explore this option in a thoughtful, informed, and compassionate way.