Dr. Aviad Hoffman

is an attending surgeon at Rambam Health Care Campus, Director of Breast Surgery and in charge of the Peritoneal Surface Malignancies Program

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HIPEC (Hyperthermic) Chemotherapy in Israel

HIPEC is a modern and highly effective method of abdominal cancer treatment, which is actively and successfully used in the Rambam Clinic.

Hyperthermal intraperitoneal chemotherapy (HIPEC) is an antitumor treatment method in which a highly concentrated heated solution of chemotherapeutic agents is injected directly into the abdominal cavity.

Unlike systemic chemotherapy where the anti-cancer drug circulates through the entire bloodstream, the HIPEC method directly targets cancer cells. This allows for higher doses of chemotherapy. The heated solution is better absorbed by tumor tissues and helps to destroy microscopic cancer cells that may have remained in the abdominal cavity after surgical removal of the tumor.

How is HIPEC carried out?

HIPEC is performed after a cytoreductive surgery to remove a visible tumor in the abdominal cavity. Cytoreductive surgery can be performed using various surgical methods. After the tumor is removed to the maximum possible extent, a sterile heated solution of chemotherapy drugs is injected into the abdomen in order to destroy cancer cells that have been left behind. The solution is heated to 41-42ºC, which corresponds to the temperature of water in a warm bath. The solution is then left in the abdominal cavity for about an hour and a half, after which it is drained and the post-op wound is stitched up.

HIPEC is an effective treatment for metastatic abdominal cancer that hasn't yet spread beyond the abdominal cavity

Advantages of HIPEC

• allows the use of high-dose chemotherapy
• directly affects cancer cells
• minimizes the negative effect of chemotherapeutic drugs on healthy organs and tissues of the body
• helps to improve the absorption of the drug by cancer cells
• reduces some of the chemotherapy side effects

The HIPEC team of experts at Rambam Hospital

The Rambam Oncology Department offers comprehensive treatment that includes cytoreductive surgery in combination with the HIPEC procedure to treat advanced stages of abdominal cancer, including colorectal, appendix, abdominal, primary peritoneal, ovarian, and stomach cancers.

Our doctors have extensive experience in performing complex cytoreductive surgeries and intraperitoneal chemotherapy. Treatment is carried out by a multidisciplinary team consisting of general oncologists, radiation oncologists, radiologists and chemotherapists. A comprehensive therapeutic plan is prepared for each patient. In addition, the patient care team that includes nutritionists, pain management specialists, physiotherapists, psychologists and psychotherapists also works with the patients to help them adapt to the treatment conditions and better cope with possible side effects of anticancer therapy

How HIPEC therapy is performed at Rambam

Before starting preoperative diagnostics and undergoing innovative anti-cancer treatment at the Rambam hospital, the patient needs to collect certain medical documents. These include:

• Medical opinion from an oncologist or a surgical oncologist including a current diagnosis, a list of all previous medical or surgical treatments, and information on the presence of concomitant diseases.
• Results of laboratory diagnostics, including general and detailed blood tests.
• Test results for the following specific proteins (tumor markers): CA 125, CEA, CA 19-9.
• Results of recent diagnostic imaging tests, such as CT, MRI or PET of the chest and abdominal cavity
• Data from other medical examinations (if available).

Preoperative examination stage before the HIPEC procedure is conducted

• Upon arrival in Israel, the patient must undergo diagnostic tests necessary to begin the treatment.
• The patient is then counseled by an oncologist and a surgical oncologist. At this stage, the doctors work together to develop a treatment plan that includes hyperthermal chemotherapy or preoperative chemotherapy. The doctors will inform the patient about all stages of the treatment, as well as the benefits and risks associated with it.
• If the patient is able to submit all the necessary medical documents required to draw up a treatment plan prior to his or her arrival in Israel, a therapeutic protocol can be developed in advance.

How is the treatment performed and how long does it take?

• The patient is hospitalized the night before the surgery. At this stage, the doctors prepare him or her for the upcoming surgery.
• The surgery is usually performed in the morning (before 8 a.m.). At the end of the procedure, the patient is transferred to the intensive care unit, where his or her condition is continuously monitored by doctors and medical staff for another 24 hours.
• The patient can stay in the hospital for 1-2 weeks. The duration of hospitalization depends on the complexity and scope of the operation, as well as the presence of any possible complications.
• It is not advisable for the patient to leave Israel for another week after discharge from the hospital. During this time, the patient will need to be checked by a surgeon.
• Upon the end of treatment and return home, the patient should also be regularly examined by an oncologist and a surgical oncologist: once every three months during the first year after treatment, and once every six months during the second year after treatment.

The evaluation of a patient's adequacy for the HIPEC procedure is based on several criteria:

1. The patient is diagnosed with colorectal cancer with metastasis in the peritoneum alone (absence of metastases in lungs, bone marrow or elsewhere). Evaluation is done through a CT or a PET-CT examination of the chest and abdomen.
2. The patient is in a proper functional state and doesn't suffer from significant comorbidities (heart, kidney and liver are working properly).

After the surgery, the patient is invited to a series of follow up appointments with the surgeon and the oncologist. In some cases, additional chemotherapy is not required.

Aside from the potential benefit to the patients' quality of life and life expectancy, one must remember that due to the complexity and scope of this procedure, postoperative complications might occur. To significantly reduce these, the pre-surgical evaluation is performed by a highly competent medical team which is well acquainted with the details of this specific procedure.