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CRS and HIPEC Surgery

Advanced Cancer Treatment Method

Advanced Cancer Treatment Method

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CRS and HIPEC are advanced cancer treatment techniques, especially effective when cancer has spread to the internal organs of the abdomen (Peritoneal Cancer).
 
In this procedure, cytoreductive surgery first removes the cancerous tumors, and then HIPEC uses high-temperature chemotherapy drugs to destroy any remaining cancer cells.
 
This surgery has proven to be life-saving for many patients and significantly increases their lifespan. In this article, we will discuss the process, benefits, and risks of CRS and HIPEC surgery.
  • How Did This Method Emerge?
In the 1980s, expert surgeon Dr. Paul Sugarbaker developed the CRS and HIPEC method. The primary goal was to use high-temperature drugs after surgery to destroy any remaining cancer cells that could not be fully removed through surgery.
  • Mainly Effective for Peritoneal Cancer
This method is particularly useful for peritoneal cancer. The peritoneum is the inner layer of the abdomen that covers the digestive organs. When cancer spreads to the peritoneum, traditional chemotherapy is often ineffective because the drugs, delivered via the bloodstream, cannot reach the peritoneum in sufficient amounts. In HIPEC, the chemotherapy drugs are delivered directly to the peritoneum, leading to better outcomes.
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CRS (Cytoreductive Surgery)

What is CRS?

Cytoreductive Surgery (CRS) is a procedure in which as much of the cancerous tumor and affected tissue as possible is removed. When cancer is widespread, chemotherapy alone is not always effective. Therefore, the goal is to remove as much of the tumor burden as possible before administering chemotherapy to enhance its effectiveness.

How is CRS Performed?

During CRS, the surgeon removes cancerous tumors that have spread to the peritoneum and surrounding areas. This procedure is long and complex because every organ and surrounding tissue needs to be thoroughly examined to remove any cancerous parts.
 
⦿ In some cases, parts of the digestive system, such as small and large intestines, may also need to be removed.

⦿ If the cancer has spread to the liver, stomach, or gallbladder, tumors from these areas are also removed.

Which Types of Cancer is CRS Useful For?

⦿ Appendix and Colorectal Cancer: When cancer spreads inside the abdomen and reaches a metastatic phase, CRS yields the best results.

⦿ Stomach Cancer: This cancer primarily spreads to the stomach or abdomen, and its symptoms may not be clearly visible in the early stages.

⦿ Ovarian Cancer: In the third and fourth stages, ovarian cancer spreads to the peritoneum and abdomen. In such cases, CRS proves to be highly effective.

⦿ Peritoneal Cancer: This cancer originates in the peritoneum, and when combined with HIPEC, CRS increases the chances of survival for the patient.

HIPEC (Hyperthermic Intraperitoneal Chemotherapy)

What is HIPEC?

HIPEC is a specialized type of chemotherapy that is administered after CRS surgery. In HIPEC, heated chemotherapy drugs are directly delivered into the patient’s abdomen. The main goal of HIPEC is to completely eliminate any remaining microscopic cancer cells that may persist after surgery.

How is the HIPEC Process Performed?

After CRS, chemotherapy drugs are heated to temperatures between 40°C to 42°C and infused into the patient’s abdomen. These drugs circulate evenly throughout the abdominal cavity, targeting and destroying any remaining cancer cells at all locations.
 
⦿ HIPEC typically lasts between 60 to 90 minutes.
 
⦿ Since the chemotherapy is contained within the abdomen, it does not affect other organs.
 
⦿ The unique feature of this method is that even at high temperatures, the treatment does not significantly affect the body’s immune system.

Key Benefits of HIPEC

Benefits_of_HIPEC_in_Cancer_Treatment
⦿ Destroys Remaining Microscopic Cancer
While CRS removes the majority of cancerous tumors, HIPEC effectively destroys any microscopic cancer cells that might remain, ensuring they are fully eradicated.
 
⦿ Reduced Side Effects
As the chemotherapy is directly delivered to the peritoneum, it avoids circulating in the bloodstream, which reduces side effects on other organs.
 
⦿ Safer from Cancer Recurrence
HIPEC reduces the risk of cancer recurring, increases the patient’s lifespan, and enhances the quality of life by minimizing future cancer-related complications.

Why are CRS and HIPEC Performed Together?
When CRS and HIPEC are combined, they provide a more effective approach to cancer treatment. After removing the tumors and cancerous tissue with CRS, HIPEC targets and destroys any remaining microscopic cancer cells.
  • Primary Goals
⦿ The aim of CRS is to completely remove the cancerous tumors.

⦿ The main goal of HIPEC is to immediately target and destroy any remaining cancer cells, preventing cancer from recurring.

⦿ Together, these two methods offer the best outcomes in advanced cancer treatment.
  • Effectiveness of Combined Treatment
⦿ Patients undergoing CRS and HIPEC together experience improved quality of life.

⦿ According to scientific reports, using these methods increases the likelihood of survival and proves to be more effective compared to other treatment options.

Preparations Before and After Surgery
  • Preparation Before Surgery
Proper preparation is essential for major surgeries like CRS and HIPEC. A thorough physical examination by the doctor, along with necessary blood tests and scans, is required.
 
⦿ Required Tests: The doctor will provide instructions for necessary scans, blood tests, and checking heart function.
 
⦿ Diet and Lifestyle: Maintaining a nutritious diet and adopting a healthy lifestyle is crucial to prepare the body for surgery.
 
⦿ Mental Preparation: Given the complexity of the surgery, both the patient and their family need appropriate emotional support.
  • Post-Surgery Care
Recovery after surgery may take time. It is important to follow all the instructions provided by the doctor.
 
⦿ Adequate Rest: The patient should take complete rest after surgery.
 
⦿ Proper Diet: A protein-rich and nutrient-filled diet is necessary for a faster recovery.
 
⦿ Prevention of Infections: To avoid any infectious diseases, maintain proper hygiene and take medications as prescribed by the doctor.
CRS (Cytoreductive Surgery) and HIPEC (Hyperthermic Intraperitoneal Chemotherapy) are complex procedures for treating peritoneal surface malignancies. Proper preparation before and after surgery is essential for successful outcomes. Here are the key preparations:
Preparation Phase Description Purpose
Before Surgery Thorough evaluation including lab tests, imaging, and consultation with surgical team. To assess overall health and suitability for surgery.
Preoperative Assessment Optimizing nutrition through oral intake or supplements before surgery. Ensures the patient has adequate energy reserves for recovery.
Nutritional Support Laxatives or enemas to cleanse the bowel and reduce infection risks during surgery. Reduces the risk of contamination during the procedure.
Bowel Preparation Counseling or support to address anxiety or concerns about the surgery. Prepares the patient psychologically for the procedure.
Mental Preparation Use of pain control methods such as medications or epidural anesthesia. To minimize discomfort and improve post-surgery recovery.
Pain Management Close monitoring of vital signs, wound healing, and signs of infection or complications. To detect and address any complications promptly.
Postoperative Monitoring Gradual reintroduction of oral intake or intravenous nutrition as tolerated. To promote healing and regain strength.
Nutritional Rehabilitation Encouraging light physical activity or exercises to improve mobility and reduce the risk of blood clots. Enhances recovery and reduces complications like DVT.
Physical Therapy Regular follow-up visits to monitor recovery, detect recurrences, and address any long-term side effects. Ensures comprehensive recovery and early detection of recurrence.
Follow-up Care Regular follow-up visits to monitor recovery, detect recurrences, and address any long-term side effects. Ensures comprehensive recovery and early detection of recurrence.

Benefits and Risks of CRS and HIPEC
Benefits and Risks of CRS and HIPEC 1
  • Benefits of CRS and HIPEC
⦿ Increased Chance of Survival
Results from CRS and HIPEC indicate that these methods can significantly increase the chances of survival for patients.
 
⦿ Reduced Risk of Cancer Recurrence
In HIPEC, heated chemotherapy drugs are directly delivered to the peritoneum, destroying remaining microscopic cancer cells, which reduces the likelihood of cancer returning.
 
⦿ More Effective Than Other Methods
Compared to other treatment methods, CRS and HIPEC have proven to be more effective in the long term.
  • Risks of CRS and HIPEC
⦿ Increased Fatigue Due to Lengthy Surgery
Since CRS and HIPEC are long and complex surgeries, patients may experience more fatigue and weakness after the procedure.
 
⦿ Longer Recovery Time
It may take up to two months for the patient to fully recover after the surgery.
 
⦿ Risk of Infection
After major surgeries, there is a higher risk of infection, so it is crucial to maintain proper care and hygiene to prevent infections.

Frequently Asked Questions
CRS removes the cancerous tumors, and HIPEC destroys any remaining small or microscopic cancer cells. Both methods combined provide better results.
No, CRS and HIPEC are most effective for cancers that have spread to the peritoneum, such as appendiceal cancer, colorectal cancer, stomach cancer, ovarian cancer, and peritoneal cancer.

The surgery typically lasts between 8 to 12 hours due to the highly specialized and complex nature of the procedure.

Yes, risks include fatigue, infection, and a longer recovery time. However, these risks can be minimized with proper care.

Complete recovery may take about 2 to 3 months after surgery. Rest and proper nutrition are essential during this time.

Yes, in HIPEC, the chemotherapy drugs are delivered directly to the peritoneum, targeting only the cancerous areas, and reducing side effects on other organs.

Yes, many medical insurance plans cover the costs of CRS and HIPEC surgery. It is important to check your policy document for details.

Yes, after recovery, the patient can return to a normal lifestyle within a few months, though regular check-ups are necessary.

If the surgery is performed properly and on time, it can improve lifestyle and reduce the risk of cancer recurrence.

In Gujarat, Apollo Hospital in Ahmedabad offers CRS and HIPEC surgery.

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Dr Harsh Shah Robotic Cancer Surgeon

Dr. Harsh Shah

MS, MCh (GI cancer Surgeon)

Dr Harsh Shah is a well known GI & HPB Robotic Cancer Surgeon in Ahmedabad. He treats cancers of Esophagus, stomach, liver, pancreas, colon, rectum & small intestines. He is available at Apollo Hospital.

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