# HIPEC / PIPAC (intraperitoneal chemotherapy)

Source: https://onco.cc/technologies/hipec/  
OnCo record `hipec` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Washing the abdominal cavity with heated chemotherapy during surgery to kill microscopic peritoneal deposits.

## Summary

HIPEC exposes the peritoneal cavity directly to chemotherapy heated to 41-43 °C during cytoreductive surgery, achieving high local drug concentration and enhanced penetration into microscopic deposits. A survival benefit was shown in ovarian cancer at interval debulking (OVHIPEC-1) and in pseudomyxoma, but the result was negative in colorectal cancer (PRODIGE 7 for oxaliplatin HIPEC), so the evidence is mixed and indication-specific. PIPAC, pressurised intraperitoneal aerosol chemotherapy, is a palliative laparoscopic alternative for patients who are not candidates for full cytoreduction. Morbidity is substantial and outcomes depend on centre expertise. The simple version is a heated chemotherapy wash of the abdomen during surgery, which helps in some cancers and not others.

## Fields

- Kind: Technology
- Status: established
- Last checked: 2026-09-04
- Principle: Direct peritoneal exposure at 41-43 °C enhances drug penetration.
- Strengths: High local concentration
- Limitations: Morbidity, centre expertise; Mixed trial results

## Notes

- The randomised result in colorectal peritoneal metastases: PRODIGE 7 added oxaliplatin hyperthermic intraperitoneal chemotherapy to complete cytoreductive surgery in 265 patients and found median overall survival of 41.7 against 41.2 months (hazard ratio 1.00), with more grade 3 or worse adverse events at 60 days in the hyperthermic arm (26 against 15 percent). Cytoreductive surgery alone is the cornerstone in this cancer (Quenet 2021); NICE NG151 (1.5.21) still routes these patients to a nationally commissioned specialist centre for the discussion.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Hyperthermic_intraperitoneal_chemotherapy
- Wikipedia: https://en.wikipedia.org/wiki/Hyperthermic_intraperitoneal_chemotherapy
- Quenet, Lancet Oncol 2021: PRODIGE 7, cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases (265 patients): https://doi.org/10.1016/s1470-2045(20)30599-4
- NICE NG151: colorectal cancer, recommendations (Lynch 1.1, local disease 1.3, biomarkers 1.4, metastatic disease 1.5, ongoing care and support including follow-up 1.6): https://www.nice.org.uk/guidance/ng151/chapter/Recommendations

## Connected records

- cancers: [Advanced and metastatic small bowel adenocarcinoma](https://onco.cc/cancers/advanced-small-bowel-adenocarcinoma/), [Appendiceal adenocarcinoma (mucinous and non-mucinous, including signet ring cell)](https://onco.cc/cancers/appendiceal-adenocarcinoma/), [Appendiceal cancer and pseudomyxoma peritonei](https://onco.cc/cancers/appendiceal/), [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Desmoplastic small round cell tumour](https://onco.cc/cancers/desmoplastic-small-round-cell-tumour/), [Gastric & gastro-oesophageal junction cancer](https://onco.cc/cancers/gastric/), [Goblet cell adenocarcinoma of the appendix](https://onco.cc/cancers/goblet-cell-adenocarcinoma/), [High-grade serous ovarian cancer](https://onco.cc/cancers/high-grade-serous-ovarian-cancer/), [Low-grade appendiceal mucinous neoplasm and pseudomyxoma peritonei](https://onco.cc/cancers/low-grade-appendiceal-mucinous-neoplasm/), [Mesothelioma](https://onco.cc/cancers/mesothelioma/), [Ovarian cancer](https://onco.cc/cancers/ovarian/), [Peritoneal mesothelioma](https://onco.cc/cancers/peritoneal-mesothelioma/)
- fronts: [Chemotherapy](https://onco.cc/fronts/chemotherapy/), [Surgery & Interventional](https://onco.cc/fronts/surgery/)
- terms: [Cytoreductive surgery](https://onco.cc/terms/cytoreductive-surgery/), [Debulking (cytoreductive surgery)](https://onco.cc/terms/debulking/), [HIPEC (hyperthermic intraperitoneal chemotherapy)](https://onco.cc/terms/hipec-procedure/), [Intraperitoneal (IP) chemotherapy](https://onco.cc/terms/intraperitoneal-chemotherapy/), [Peritoneal cancer index](https://onco.cc/terms/peritoneal-carcinomatosis-index/), [Peritoneal metastases from bowel cancer](https://onco.cc/terms/colorectal-peritoneal-metastases/), [Peritoneal metastasis](https://onco.cc/terms/peritoneal-metastasis/), [Systemic versus local therapy](https://onco.cc/terms/systemic-vs-local-therapy/)
- ideas: [Find peritoneal spread while it is still small, and run complete cytoreduction through networks rather than adding heated chemotherapy](https://onco.cc/ideas/idea-crc-peritoneal-disease-found-early-and-treated-in-networks/), [Mandatory staged registries for new surgical techniques before wide adoption](https://onco.cc/ideas/idea-fund-device-technique-registry/), [Peritoneal-directed therapy for gastric cancer](https://onco.cc/ideas/idea-peritoneal-directed-gastric/), [Treat the body cavity, not the bloodstream, for surface spread](https://onco.cc/ideas/idea-bio2-intracavitary-immunotherapy/)
- trials: [Adjuvant Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) in Resected High Risk Colon Cancer Patients](https://onco.cc/trials/nct03280511/), [COLOPEC](https://onco.cc/trials/colopec/), [Efficacy of Hyperthermic Intraperitoneal Chemotherapy](https://onco.cc/trials/nct04861558/), [Efficacy of the Use of Neoadjuvant With/Without Hyperthermic Intraperitoneal Chemotherapy in the Treatment of Locally Advanced Colon Cancer](https://onco.cc/trials/nct06783491/), [Netherlands Cancer Institute HIPEC trial](https://onco.cc/trials/netherlands-hipec/), [OVHIPEC-1](https://onco.cc/trials/ovhipec-1/), [Perioperative Systemic Therapy for Isolated Resectable Colorectal Peritoneal Metastases](https://onco.cc/trials/nct02758951/), [Pressurized Intraperitoneal Aerosolized Chemotherapy With Mitomycin for the Treatment of Unresectable Appendix or Colorectal Cancer With Peritoneal Metastases,](https://onco.cc/trials/nct07271355/), [PRODIGE 7](https://onco.cc/trials/prodige-7/), [Prophylactic PIPAC in Patients With High-risk Colorectal Cancer](https://onco.cc/trials/nct06839092/), [PROPHYLOCHIP-PRODIGE 15](https://onco.cc/trials/prophylochip/), [Systemic Antitumor Treatment with or Without Pressurized Intraperitoneal Aerosol Chemotherapy for Colon Peritoneal Metastases (PIPOX02)](https://onco.cc/trials/nct06681038/)
- pairings: [HIPEC at interval cytoreductive surgery](https://onco.cc/pairings/hipec-at-interval-surgery/)
- key papers: [Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy versus cytoreductive surgery alone for colorectal peritoneal metastases (PRODIGE 7)](https://onco.cc/key-papers/paper-quenet-prodige-7-hipec-peritoneal-colorectal-lancet-oncol-2021/), [Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer](https://onco.cc/key-papers/paper-verwaal-cytoreduction-hipec-peritoneal-colorectal-jco-2003/)
- roadmaps: [Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation](https://onco.cc/roadmaps/colorectal-roadmap/), [Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work](https://onco.cc/roadmaps/surgery-roadmap/)
- institutions: [European Society of Gynaecological Oncology](https://onco.cc/institutions/esgo/), [European Society of Surgical Oncology](https://onco.cc/institutions/esso/), [First Affiliated Hospital of Sun Yat-sen University](https://onco.cc/institutions/sysu-first-affiliated-hospital/), [Fondazione IRCCS Istituto Nazionale dei Tumori](https://onco.cc/institutions/int-milan/), [Society of Surgical Oncology](https://onco.cc/institutions/sso/)
- people: [Willemien J. van Driel](https://onco.cc/people/willemien-van-driel/)
- drugs: [Mitomycin C](https://onco.cc/drugs/mitomycin/)
- pathways: [Organ tropism: seed and soil](https://onco.cc/pathways/organ-tropism-seed-soil/)
- companies: [Belmont Medical Technologies](https://onco.cc/companies/belmont-medical-technologies/), [Capnomed (Reger Medizintechnik)](https://onco.cc/companies/capnomed/), [UNICANCER](https://onco.cc/companies/unicancer/)
- technologies: [HIPEC perfusion pumps and PIPAC nebulisers](https://onco.cc/technologies/hipec-pipac-devices/)

---
JSON: https://onco.cc/api/v1/entities/hipec.json