HIPEC (Hyperthermic Intraperitoneal Chemotherapy) has moved from “experimental” to standard-of-care in selected ovarian and peritoneal cancers over the past decade. This is the definitive 2026 patient guide to HIPEC in India — written for patients, families, and referring physicians who want a clear, evidence-based reference.
On this page
- 1. What HIPEC actually is
- 2. Why heated chemotherapy works
- 3. Who is a candidate
- 4. When HIPEC is NOT appropriate
- 5. The procedure step-by-step
- 6. What the evidence shows
- 7. HIPEC vs PIPAC
- 8. Hospital stay and recovery
- 9. Cost in India
- 10. Centres performing HIPEC in India
- 11. What outcomes to expect
- 12. Questions to ask before HIPEC
- 13. FAQ
Hipec india complete guide — 1. What HIPEC actually is
HIPEC stands for Hyperthermic Intraperitoneal Chemotherapy. It is heated chemotherapy circulated directly inside the abdominal cavity for 60–90 minutes, immediately after the surgeon has removed all visible cancer (cytoreductive surgery, or CRS).
The temperature (41–43°C) and the direct contact target microscopic cancer cells that remain on the peritoneal surfaces after surgery — disease that systemic chemotherapy alone cannot eradicate. The combination of CRS + HIPEC is performed in a single operating theatre session, typically lasting 6–10 hours.
2. Why heated chemotherapy works
Three biological reasons:
- Direct contact — chemotherapy concentration on the peritoneal surface is 20–100× higher than achievable with intravenous chemo.
- Heat sensitises cancer cells — at 41–43°C, cancer cells are damaged by heat alone AND become more sensitive to the chemotherapy effect.
- Immediate post-resection delivery — kills microscopic residual disease before it can establish.
3. Who is a candidate for HIPEC?
HIPEC is most established for:
- Advanced ovarian cancer (Stage 3, particularly at interval cytoreduction after neoadjuvant chemotherapy)
- Primary peritoneal cancer
- Pseudomyxoma peritonei (from appendiceal mucinous tumours)
- Selected colorectal cancers with peritoneal-only metastasis (LRP)
- Selected uterine sarcoma with peritoneal spread
- Mesothelioma of the peritoneum
4. When HIPEC is NOT appropriate
Equally important is knowing when HIPEC will NOT help:
- Disease that cannot be completely resected (CC-0/1 not achievable)
- Distant metastasis (liver parenchymal disease, lung mets) — these need systemic treatment first
- Poor performance status (Karnofsky < 70%)
- PCI score very high (typically > 20–25 depending on histology)
- Severe medical comorbidities making 6–10 hour surgery unsafe
Patient selection is the single biggest determinant of outcomes. See 9 factors that affect HIPEC success for the full framework.
5. The procedure step-by-step
- Anaesthesia and access — general anaesthesia, midline incision, full exploratory laparotomy.
- Cytoreductive surgery — systematic removal of all visible disease across all peritoneal regions. May include hysterectomy, oophorectomy, omentectomy, peritonectomy, splenectomy, bowel resection. Goal is CC-0 (no residual disease).
- HIPEC delivery — surgeon places inflow and outflow cannulae; abdomen is filled with heated chemotherapy solution; perfusion at 41–43°C for 60–90 minutes (timing depends on drug); patient’s temperature is closely monitored.
- Bowel reconstruction — anastomoses if bowel was resected (timing — before or after HIPEC — is debated; see Dr. Nishtha’s research).
- Closure — fascial closure, drains placed, transfer to ICU.
6. What the evidence shows
The landmark Van Driel et al. 2018 NEJM trial randomised 245 women with Stage 3 ovarian cancer to interval cytoreductive surgery alone vs. interval cytoreductive surgery + HIPEC. The HIPEC arm had:
- Median recurrence-free survival: 14.2 months (HIPEC) vs 10.7 months (control)
- Median overall survival: 45.7 months (HIPEC) vs 33.9 months (control)
- No significant increase in serious adverse events
This was the first Level 1 evidence specifically for HIPEC in ovarian cancer. Subsequent confirmatory studies and meta-analyses have supported these findings.
7. HIPEC vs PIPAC — when each is used
HIPEC: single procedure, open surgery, after maximal cytoreduction, at initial or interval surgery. Best evidence for ovarian and pseudomyxoma.
PIPAC (Pressurised Intraperitoneal Aerosol Chemotherapy): repeat laparoscopic procedure (typically 3 cycles, 6 weeks apart), for recurrent or unresectable peritoneal disease. Lower per-procedure burden; can be combined with systemic chemotherapy. See PIPAC overview.
8. Hospital stay and recovery timeline
- Surgery: 6–10 hours
- ICU: 1–3 days (mainly for monitoring; most patients are extubated quickly)
- Ward: 5–8 days
- Total hospital stay: 7–10 days (with enhanced recovery protocols)
- Light activity: 4–6 weeks
- Normal life: 8–12 weeks
- Adjuvant chemotherapy: starts at 4–6 weeks if planned
For research on optimising recovery, see ERAS in CRS+HIPEC — Dr. Nishtha’s paper.
9. Cost in India
Total HIPEC + CRS at tier-1 Ahmedabad hospitals ranges Rs 5–12 lakh including the procedure, hospital stay (7–10 days), anaesthesia, ICU, and standard pre-op work-up. For honest cost breakdown see our dedicated HIPEC cost page.
10. Centres performing HIPEC in India
HIPEC programmes require specific infrastructure: trained anaesthesia team, perfusion technology, oncology pharmacy for chemo preparation, intensive care backup, and a surgical team performing 25+ procedures annually. Established programmes include:
- Tata Memorial Centre (Mumbai)
- AIIMS (New Delhi)
- HCG Cancer Centre (Bangalore, Ahmedabad)
- Apollo (multiple cities including Ahmedabad)
- Sterling Hospitals (Ahmedabad) — where Dr. Nishtha performs HIPEC. See our Sterling HIPEC page
11. What outcomes to expect
In carefully selected patients receiving optimal CRS + HIPEC:
- Median overall survival in Stage 3 ovarian cancer: 4–5 years (vs 3–4 years without HIPEC)
- 30-day mortality: 1–3% at high-volume centres (versus 5–10% at low-volume centres)
- Major complication rate: 15–25% (Clavien-Dindo Grade III+)
- Long-term remission: 25–40% are alive and disease-free at 5 years for Stage 3 disease
12. Questions to ask before HIPEC
- What is your team’s annual HIPEC volume?
- What is your CC-0/CC-1 rate?
- What is your 30-day mortality and major complication rate?
- Who performs the HIPEC perfusion — anaesthesia or surgeon-managed?
- Will my case be discussed at multidisciplinary tumour board before surgery?
- What is the proposed chemotherapy drug, dose and duration?
- Will I have a written quote before admission?
- How does the team handle complications if they occur?
Frequently Asked Questions
Is HIPEC painful?
The surgery itself is performed under general anaesthesia. Post-operative pain is managed with multimodal analgesia (epidural, IV opioids, regional blocks). Most patients are mobilised within 24–48 hours and pain is well-controlled.
How is HIPEC different from regular chemotherapy?
Regular (systemic) chemotherapy is given intravenously and circulates through the bloodstream. HIPEC is delivered directly into the abdominal cavity at high concentration and heated to enhance effect. HIPEC targets microscopic residual disease that IV chemo cannot reach.
Will I lose my hair with HIPEC?
Standard HIPEC drugs (cisplatin, mitomycin-C, oxaliplatin) used at HIPEC doses cause less hair loss than full systemic chemotherapy. However, most patients also receive systemic chemo before or after HIPEC, which does cause hair loss.
What is the success rate of HIPEC?
Success depends heavily on patient selection. In appropriately selected Stage 3 ovarian cancer, the Van Driel NEJM trial showed 12-month improvement in overall survival. Approximately 25–40% of selected patients are alive and disease-free at 5 years.
Can HIPEC be repeated?
HIPEC is usually a one-time procedure during initial or interval surgery. For recurrent disease, PIPAC (which can be repeated multiple times) is more appropriate.
What if I am not eligible for HIPEC?
Many patients benefit from cytoreductive surgery alone, PIPAC, systemic chemotherapy, or targeted therapy. Eligibility for HIPEC does not determine prognosis — other excellent options exist.
Is HIPEC covered by insurance in India?
Most cashless health insurance policies cover HIPEC under cancer surgery benefits. Pre-authorisation is required and may take 24–72 hours. PMJAY covers eligible patients up to Rs 5 lakh per year.
How do I get a second opinion before deciding?
Share your reports on WhatsApp at +91 76988 00333. Dr. Nishtha provides independent review within 24–48 hours. Second opinions are free and you don’t have to switch hospitals.
Is HIPEC available in Ahmedabad?
Yes. See our HIPEC at Sterling Hospitals page for specifics on the Ahmedabad programme.
What is the role of PIPAC?
PIPAC is for recurrent peritoneal disease or unresectable cases where HIPEC is not feasible. It is a separate, complementary technique. See PIPAC overview.
Medical content reviewed by Dr. Nishtha Tripathi Patel, MBBS, DGO, DNB, Fellowship Gynaecological Oncology, ESGO-certified. For consultations: WhatsApp +91 76988 00333.