HJBR Sep/Oct 2022

54 SEP / OCT 2022 I  HEALTHCARE JOURNAL OF BATON ROUGE ONCOLOGY DIAL GUE COLUMN ONCOLOGY New Hope for Cancer Patients in Baton Rouge UNFORTUNATELY, with the high incidence of colon cancer and the limited access to care for many patients, resulting in suboptimal screening colonoscopy rates, we encounter many patients with advanced disease and peritoneal metastasis at presentation. In fact, we sometimes see peritoneal metastasis fol- lowing resection of early-stage colon can- cer, especially in those who do not adhere to postoperative cancer surveillance, and they later present with advanced peritoneal dis- ease. Now what? Palliative chemotherapy? Hospice care? For some patients with peritoneal metas- tasis, Cytoreductive Surgery (CRS) and Hy- perthermic Intraperitoneal Chemotherapy (HIPEC) can provide hope and even pro- long survival. Moreover, it is the only cura- tive option for some appendiceal mucinous neoplasms, which do not typically respond to traditional IV chemotherapy. So, what is HIPEC? How does it work? And how do we decide on which patient would benefit from this surgery? WHAT IS HIPEC? HIPEC stands for Hyperthermic (or heat- ed) intraperitoneal chemotherapy, which is usually a two-stage surgery that starts with cytoreductive surgery in which all the visible metastasis is surgically removed to achieve what’s called complete cytoreduction (CC), and then chemotherapy heated to 42-43 de- grees Celsius is infused into the abdomen and circulated for 60-90 minutes to eradicate the microscopic tumor cells. The circulation and heating of the chemotherapy is achieved through a commercial infusion machine that delivers the heated chemotherapy to the patient through a circuit of inflow and outflow tubing, which allows for monitor- ing of flow rate and temperature through- out the treatment session. This surgery, in its modern form, started back in 1979 and has undergone substantial improvements and increased utilization since. The indications for this surgery have also expanded over the past two decades with multiple clinical trials evaluating its effectiveness for various peri- toneal diseases, but not without controversy. HOW DOES HIPEC WORK? The cytoreductive portion of this surgery involves removal of the macroscopic dis- ease. This usually involves removal of the entire peritoneum, including the diaphrag- matic and pelvic peritoneum, greater and