Continuous hyperthermic peritoneal perfusion (CHPP)
Continuous hyperthermic peritoneal perfusion (CHPP) is a medical procedure designed to deliver heated chemotherapy directly to the abdominal cavity, often used during or immediately after abdominal surgery. The technique is particularly relevant for treating various cancers, including primary mesothelioma, stomach cancer, ovarian cancer, and certain recurrent cancers. One of the key advantages of CHPP is that the heat enhances the sensitivity of cancer cells to chemotherapy and other treatments while allowing for targeted delivery to residual cancer cells post-surgery, minimizing damage to healthy tissue.
During the procedure, the abdominal cavity is heated to temperatures between 106 to 108 degrees Fahrenheit (41 to 42 degrees Celsius) for a duration of 45 minutes to two hours. Prior to CHPP, patients undergo general anesthesia and bowel cleansing, similar to standard abdominal surgeries. Recovery typically involves an initial stay in the intensive care unit (ICU) for monitoring.
While CHPP has shown promise in improving survival rates and reducing metastasis, it does carry risks such as bleeding, infection, and potential damage to surrounding tissues or organs. Most adverse effects are temporary, but some serious complications can occur. Overall, CHPP represents a targeted approach in cancer treatment, aiming for greater efficacy in eradicating cancer cells while preserving normal cellular function.
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Continuous hyperthermic peritoneal perfusion (CHPP)
ALSO KNOWN AS: Intraperitoneal hyperthermic perfusion, hyperthermic intraperitoneal chemotherapy (HIPEC)
DEFINITION: Continuous hyperthermic peritoneal perfusion (CHPP) is a procedure that delivers highly heated fluid containing chemotherapeutic agents directly to the abdominal cavity, often during or immediately after abdominal surgery.
Cancers treated: Primary mesothelioma; primary stomach cancers; recurrent or widely spread ovarian cancers; recurrent colon cancer; cancers in the lung, breast, or appendix that have spread
Why performed: The benefits of CHPP are twofold. First, hyperthermia increases cancer cell sensitivity to other treatments (radiotherapy and chemotherapy) and increases the effectiveness of some chemotherapy (such as mitomycin-C) through improved pharmacokinetics. Second, regional administration allows for the direct treatment of errant cancer cells that remain after tumor excision while preserving noncancerous cells.
Patient preparation: Preparation is similar to that of any abdominal surgery. The patient’s bowel must be cleansed, and the patient must fast on the day of the procedure. Before surgery and CHPP, intravenous lines are inserted, and general anesthesia is administered. During surgery, the body temperature may be allowed to drop by 3 to 5 degrees Fahrenheit to accommodate impending hyperthermia.
Steps of the procedure: The effectiveness of CHPP is related to the maintenance of a narrow temperature range for a prescribed time, so administration must be monitored closely. First, fluid-delivery tubing and thermometer probes are inserted into the abdominal cavity. Fluid is heated outside the body and is pumped in via to bathe the area, usually at 106 to 108 degrees Fahrenheit (41 to 42 degrees Celsius), for forty-five minutes to two hours. Then, the fluids are removed with draining tubes.
After the procedure: After CHPP, the patient’s is closed, as with any abdominal surgery. Initial recovery in the intensive care unit (ICU) involves the evaluation of surgical recovery and may require temporary feeding tubes.
Risks: Because surgery and CHPP are often performed together, it is difficult to separate their complications, which include bleeding, infection, and wound-healing problems. Although most normal tissue remains intact to 111 degrees Fahrenheit (44 degrees Celsius), the death of normal cells is possible with hyperthermia. Most adverse effects of CHPP are temporary and include local pain, local blood clots, and burns or blisters to the skin, muscles, and nerves. More seriously, damage to blood vessels or to the lungs and heart may occur.
Results: Like systemic chemotherapy, the goal of CHPP is to destroy cancer cells in the peritoneal cavity. Unlike systemic therapy, CHPP aims to eradicate lingering cancer cells directly without affecting normal cells. According to a study in 2022 by Scientific Reports, CHPP may improve the survival rate of stomach cancer patients after radical gastrectomy. Furthermore, it has been shown to reduce the risk of stomach cancer metastasis and effectively prevent peritoneal, or abdominal, metastasis.
Bibliography
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Dovern, E., et al. "Hyperthermic Intraperitoneal Chemotherapy Added to the Treatment of Ovarian Cancer. A Review of Achieved Results and Complications." European Jour. of Gynaecological Oncology 31.3 (2010): 256–261. Print.
Elias, D., et al. "Review: Role Hyperthermic Intraoperative Peritoneal Chemotherapy in the Management of Peritoneal Metastases." European Jour. of Cancer 50.2 (2014): 332–340. Print.
Gonzalez-Moreno, Santiago, Luis A. Gonzalez-Bayon, and Gloria Ortega-Perez. "Hyperthermic Intraperitoneal Chemotherapy: Rationale and Technique." World Jour. of Gastrointestinal Oncology 2.2 (2010): 68–75. NCBI. Web. 17 Sept. 2014.
Natl. Cancer Inst. "National Cancer Institute FactSheet: Hyperthermia in Cancer Treatment." Cancer.gov. NCI, 31 Aug. 2011. Web. 17 Sept. 2014.
Ryu, K. S., et al. "Effects of Intraperitoneal Hyperthermic Chemotherapy in Ovarian Cancer." Gynecologic Oncology 94.2 (2004): 325–332. Print.
Sommariva, Antonio, et al. "Hot Topic: Cyto-Reductive Surgery Combined with Hyperthermic Intra-Peritoneal Chemotherapy for Peritoneal Surface Malignancies: Current Treatment and Results." Cancer Treatment Reviews 38.4 (2012): 258–268. Print.
Zhuang, X., et al. "Prophylactic Hyperthermic Intraperitoneal Chemotherapy May Benefit the Long-Term Survival of Patients After Radical Gastric Cancer Surgery." Sci Rep 12, 2583 (2022). https://doi.org/10.1038/s41598-022-06417-y. Accessed 11 July 2024.