The short answer: HIPEC (heated chemotherapy washed through the belly during surgery, called garam chemo in Hindi — पेट के अंदर गर्म कीमोथेरेपी) can help some women with advanced ovarian cancer (अंडाशय का कैंसर, andashay ka cancer), but it is not for everyone and it is not a guaranteed cure. It is considered for selected women with stage 3 (sometimes stage 4) disease when all visible tumour can be removed and they are fit for a long operation. The strongest evidence is for HIPEC at interval surgery, after about three cycles of chemotherapy. Read more about HIPEC eligibility and treatment and the wider ovarian cancer diagnosis and treatment pathway.
On this page
- What Is HIPEC?
- Why HIPEC Matters for Ovarian Cancer
- The HIPEC Procedure: Step by Step
- Who Is a Candidate for HIPEC?
What Is HIPEC?
HIPEC — hyperthermic intraperitoneal chemotherapy — is a procedure in which heated chemotherapy solution (40–42°C) is circulated directly within the abdominal cavity immediately after cytoreductive surgery. The heat enhances drug penetration into residual microscopic cancer deposits on the peritoneal surface, while the localised delivery limits the systemic side effects of chemotherapy.
Why HIPEC Matters for Ovarian Cancer
Advanced ovarian cancer frequently spreads across the peritoneum — the membrane lining the abdominal cavity. Even after optimal cytoreductive surgery removes all visible tumour, microscopic residual disease on the peritoneal surface is what drives recurrence. Systemic intravenous chemotherapy has limited penetration into peritoneal deposits. HIPEC addresses this gap directly.
The landmark OVHIPEC-1 trial (van Driel et al., New England Journal of Medicine, 2018) included 245 women with stage III ovarian cancer who had three cycles of chemotherapy before surgery (interval surgery). Adding HIPEC with cisplatin improved median recurrence-free survival (the time before the cancer came back) from 10.7 to 14.2 months, and median overall survival from 33.9 to 45.7 months. Serious side effects were similar in both groups.
The evidence for HIPEC at upfront (surgery-first) operations is weaker. A Korean trial (Lim et al., JAMA Surgery 2022; 184 women) found no overall benefit when surgery-first and interval-surgery patients were counted together; a benefit was seen only in the interval-surgery group. This is why HIPEC is offered selectively, mainly at interval surgery.
The HIPEC Procedure: Step by Step
- Cytoreductive surgery — all visible tumour is removed, including omentectomy, peritoneal stripping, and any organ resection required to achieve complete cytoreduction (R0)
- Perfusion circuit setup — inflow and outflow catheters are placed in the abdominal cavity, connected to a closed-circuit heating machine
- HIPEC delivery — heated cisplatin solution is circulated at 40–42°C for 90 minutes while the abdomen is gently rocked to ensure even distribution
- Drainage and closure — the chemotherapy solution is drained, the abdomen is irrigated, and the incision is closed
Who Is a Candidate for HIPEC?
HIPEC is not appropriate for every ovarian cancer patient. The strongest evidence supports its use in:
- Stage III ovarian cancer undergoing interval cytoreductive surgery after neoadjuvant chemotherapy
- Patients in whom complete or optimal cytoreduction can be achieved
- Patients with adequate performance status (ECOG 0–1) and organ function
The heated chemotherapy itself takes about 90 minutes and makes an already long operation longer; the whole surgery often takes 8–14 hours. It also makes care after surgery more complex. Hospital stay is usually 10–14 days, including 3–5 days in intensive care. For what to expect before and after the operation, read about preparation and recovery around HIPEC. Patients should be managed at centres with dedicated HIPEC infrastructure and multidisciplinary oncology support.
Dr. Nishtha Tripathi Patel performs cytoreductive surgery with HIPEC at Sterling Hospitals (Sindhubhavan Road) and KD Hospital, Ahmedabad. You can also consult her at Welcare Speciality Hospital; if HIPEC is advised, the operation is done at Sterling or KD. Contact: +91 76988 00333.
Related and References
- Internal: Ovarian cancer overview
- Internal: About Dr. Nishtha Tripathi Patel
- External: Van Driel et al., NEJM HIPEC trial