The short answer: HIPEC (hyperthermic intraperitoneal chemotherapy) is heated chemotherapy washed through the belly during a long cancer operation, right after the surgeon has removed all visible tumour. In Hindi it is often called garam chemo (पेट के अंदर गर्म कीमोथेरेपी). It is not for everyone and it is not a guaranteed cure. It is considered for selected women with stage 3 (sometimes stage 4) ovarian cancer when all visible tumour can be removed and they are fit for a long operation. The evidence is strongest when surgery comes after about three cycles of chemotherapy (interval surgery). Whether you are a candidate is decided case by case; read about HIPEC eligibility and treatment.
This guide covers the questions patients in India ask most: how long the operation and hospital stay take, cost and insurance, what the research really shows, and what to ask your team.
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
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). In gynaecological cancers it is used mainly for advanced ovarian cancer, as one part of a wider plan that also includes surgery and chemotherapy through a vein; see ovarian cancer diagnosis and treatment.
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, often lasting 8–14 hours depending on how much cancer has to be removed.
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 problems that make a long (often 8–14 hour) operation 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)
- Serious (grade 3–4) side effects were similar in both groups (about 1 in 4 women)
“Median” means the middle value: half of the women lived longer than this and half did not. All women in this trial (OVHIPEC-1) had three cycles of chemotherapy before surgery (interval surgery), and that is where the evidence for HIPEC is strongest. Later research is more mixed:
- A Korean trial (Lim et al., JAMA Surgery 2022; 184 women with stage 3–4 ovarian cancer) found no overall benefit when surgery-first and interval-surgery patients were counted together. A benefit was seen in the interval-surgery group, but not in the surgery-first group.
- A 2025 review of eight randomised trials (European Journal of Surgical Oncology) found longer overall survival with HIPEC, but no clear survival benefit for recurrent cancer. HIPEC also added about two hours of operating time, a slightly longer hospital stay and more serious complications.
In short: HIPEC is a reasonable option for selected women at interval surgery. It is not proven for upfront (surgery-first) operations or for most recurrences, and it is not a guaranteed cure.
7. HIPEC vs PIPAC — when each is used
HIPEC: single procedure, open surgery, after maximal cytoreduction. In ovarian cancer the evidence is for interval surgery (after chemotherapy); its value at upfront surgery is not proven. Best evidence for ovarian cancer at interval surgery and for 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: often 8–14 hours
- ICU (intensive care): usually 3–5 days
- Total hospital stay: usually 10–14 days, including the ICU days
- Light activity: about 4–6 weeks
- Full recovery: about 3–4 months
- Adjuvant chemotherapy: starts at 4–6 weeks if planned
Recovery is different for every patient; age, fitness, how much surgery was needed and any complications all matter. For a step-by-step guide, read about preparation and recovery around HIPEC.
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 (usually 10–14 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 (Sindhubhavan Road) and KD Hospital, Ahmedabad — where Dr. Nishtha performs HIPEC. See our Sterling HIPEC page and KD Hospital HIPEC page
11. What outcomes to expect
Results depend on the type of cancer, how much can be removed and your fitness. In carefully selected patients receiving optimal CRS + HIPEC:
- Median overall survival in stage 3 ovarian cancer at interval surgery (OVHIPEC-1): 45.7 months with HIPEC vs 33.9 months without, about 12 months longer
- Median time before the cancer came back: 14.2 vs 10.7 months, so most women still needed further treatment later
- 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+)
Ask your team for their own complication and survival figures. HIPEC can add time for selected women, but it is not a guaranteed cure.
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 the main trial of women with stage 3 ovarian cancer having interval surgery after chemotherapy (van Driel et al., NEJM 2018), median overall survival was about 12 months longer with HIPEC (45.7 vs 33.9 months). Most women still had the cancer come back at some point, so HIPEC is not a guaranteed cure, and a benefit at upfront (surgery-first) operations is not proven.
Can HIPEC be repeated?
HIPEC is usually a one-time procedure, done during the main cancer operation. For recurrent disease the options are decided case by case: chemotherapy, sometimes a second operation, or in selected cases PIPAC (which can be repeated).
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 families up to Rs 5 lakh per family 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. Dr. Nishtha performs HIPEC at Sterling Hospitals (Sindhubhavan Road) and KD Hospital, Ahmedabad. You can also consult her at Welcare Speciality Hospital, but HIPEC surgery is done at Sterling or KD. See our HIPEC at Sterling Hospitals page and HIPEC at KD Hospital page.
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.