Medically Reviewed By: Dr. Neeraj Goel, MBBS, MS, MCh (GI Surgical Oncology)
Designation: Director – GI Oncology, Peritoneal Surface Malignancy & Advanced Cancer Surgery
Clinical Review Date: August 18, 2026
Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a combined treatment for cancers that have spread across the inner lining of the belly (the peritoneum).
The procedure works in two steps:
Years ago, abdominal peritoneal spread was seen as untreatable. Today, combining aggressive surgery with heated local chemotherapy gives carefully selected patients a realistic chance at long-term disease control.
The peritoneum is a smooth membrane that lines your abdominal wall and covers your internal organs.
When cancer cells break free from a primary tumor in the colon, appendix, or stomach, they float in the abdominal fluid and seed themselves across this lining. This pattern of spread is known as peritoneal metastases or peritoneal carcinomatosis. Because standard intravenous chemotherapy struggles to reach high concentrations on this tissue lining, delivering heated medicine directly inside the belly works far better.
Not every cancer that reaches the abdomen can be treated this way, but it is effective for specific conditions:
At first, peritoneal deposits are tiny and cause no pain at all. As fluid accumulates or deposits grow larger, common warning signs appear:
Selecting the right patient is the single most important step in achieving a good outcome:
The goal is simple: clear away every speck of visible tumor.
Depending on where the tumor has traveled, CRS can be a major, hours-long operation. The surgeon may need to remove parts of the peritoneum, the fatty omentum, sections of the small or large bowel, the gallbladder, the spleen, or deposits sitting along the diaphragm muscle.
Once the visible tumors are out, heated chemotherapy is delivered before closing the incisions:
CRS-HIPEC is recommended when:
It is not recommended if the cancer has spread heavily to the lungs, bones, or liver, or if tumors are too widely attached to the entire small bowel to be safely resected.
Because CRS-HIPEC is a major operation, recovery requires a coordinated hospital team:
Managing peritoneal disease comes down to patient selection and operative thoroughness. When complete tumor clearance is achieved prior to delivering HIPEC, long-term survival and remission rates improve significantly. Our surgical protocols, combined with modern critical care, allow most of our patients to recover smoothly and return home within 8 to 10 days.
For localized peritoneal cancers and conditions like Pseudomyxoma Peritonei (PMP), complete surgical removal combined with HIPEC can be curative or provide long periods of remission.
The operation typically takes between 6 and 10 hours depending on how many tumor deposits need to be removed before the 60-to-90-minute chemo wash begins.
Standard chemo travels through the bloodstream and struggles to reach the peritoneum in high amounts. HIPEC delivers a high concentration of heated medication directly to the abdominal surfaces with limited absorption into the rest of the body.
Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) is a minimally invasive keyhole method that delivers chemotherapy as a fine mist directly into the abdomen. It is used for patients who may not be candidates for full cytoreductive surgery.
