Dr. Fernando Arias

the meat and potatoes of HIPEC

So I have returned to the United States and back on assignment for the next couple of months, so it’s time to get down to business.

A couple of new HIPEC articles came out – which I thought readers might enjoy.  For lighter fare, we will start with an article from the Vancouver Sun.

The first article, by Erin Ellis of the Vancouver Sun, is a Canadian fluff piece complete with sensationalistic headlines and dramatic patient interviews designed to draw attention to Vancouver General Hospital’s new HIPEC program.

 Dr. Fernando Arias

Dr. Fernando Arias, Chief of the HIPEC program at Santa Fe de Bogotá

Now for the meat and potatoes

The second article, which is more academically and scientifically based, is  focused on a study presented at the Southern Surgical Association  in December by Levine, et. al. (2014) “Intraperitoneal Chemotherapy for Peritoneal Surface Malignancy: Experience with 1,000 Patients” looks at long-term survival with HIPEC in patients with disseminated peritoneal malignancies.  This study is remarkable for both the duration of the prospective study (which began in 1991) and the large amount of participants for a single site study.  The vast majority of patients enrolled in this study had appendiceal cancer as their primary, but the study also included patients with ovarian, gastric, mesothelioma and colorectal cancers.

The evolution of the procedure and institutional experience led to improved outcomes and reduced complications over the course of the study.  Part of this was due to the development of better patient selection criteria.

This information comes as a ray of hope for patients with these diagnoses and previously given only dismal prognoses.

Dr. Edward Levine, the primary investigator, is the Chief of Surgical Oncology and Director of the Comprehensive Cancer Center at Wake Forest Medical Center in North Carolina.

It was published in the Journal of the American College of Surgeons, and summarized here, at Heme/Onc Today

Levine, et. al. (2014).  Intraperitoneal Chemotherapy for Peritoneal Surface Malignancy: Experience with 1,000 Patients.  Journal of the American College of Surgeons, 218(4): 573–585 (April 2014).  No free text available.

Additional HIPEC posts: the HIPEC archives 

HIPEC hits its stride

When I first started reading and writing about HIPEC (after meeting Dr. Arias in Bogota), I was met with a lot of skepticism and sometimes even ridicule, primarily from American physicians.

Several of them derided HIPEC with a vehemence that was unexpected – a vigor that was quite surprising and almost venomous in nature.  I was accused of being ignorant, or more maliciously, a possible fraud or trickster – even when I explained my sources (scientific and medical journals) and reminded critics that I was on a fact-finding mission, not a sales pitch.

I don’t sell HIPEC.  I don’t sell any medical equipment, treatment, or procedures. I don’t market or sell surgeons.  About the only thing I sell  is the occasional copy of one of my books.

No – I don’t sell much.  Instead, I write, I research and I do my best to provide information, and resources to people who are interested in the same topics.  As a healthcare provider, my reasons for writing about these topics may very well differ from my readers – but that’s more perspective than anything else.

When it comes to HIPEC – I was attracted because HIPEC offers hope.  Not in a wild, faith-healing, magic pill , “100% absolutely guaranteed, for positively everyone” kind of way, but in a quiet, evolving medicine kind of way.. Meaning that we are still learning about it -and who it can help..

So it was disappointing to have that hope dimmed by other medical professionals, but then – sometimes procedures and treatments that sound promising DO end up disappointing.  So I’ve kept an eye on the research, and kept reading..

It’s been a on-going process.. Imagine my delight to see that over SIXTY articles have been published in medical & research journals on HIPEC in just the last six months.. Some with great results, some okay, – some detailing complications..

(I’ve posted some of the citations here).  Most of the articles aren’t free but there is a notation to the ones that are.

1. Intrapleural hyperthermic perfusion chemotherapy in subjects with metastatic pleural malignancies.
  Işık AF, Sanlı M, Yılmaz M, Meteroğlu F, Dikensoy O, Sevinç A, Camcı C, Tunçözgür B, Elbeyli L.
  Respir Med. 2013 May;107(5):762-7. doi: 10.1016/j.rmed.2013.01.010. Epub 2013 Feb 23.
  PMID: 23462236 [PubMed – in process]  This is actually HITHOC
  Related citations
2. Patients at risk for peritoneal surface malignancy of colorectal cancer origin: the role of second look laparotomy.
  Brücher B, Stojadinovic A, Bilchik A, Protic M, Daumer M, Nissan A, Itzhak A.
  J Cancer. 2013;4(3):262-9. doi: 10.7150/jca.5831. Epub 2013 Mar 15.
  PMID: 23459716 [PubMed] Free PMC Article
  Related citations
3. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis (HIPEC): the Danish experience.
  Iversen LH, Rasmussen PC, Hagemann-Madsen R, Laurberg S.
  Colorectal Dis. 2013 Mar 4. doi: 10.1111/codi.12185. [Epub ahead of print]
  PMID: 23458368 [PubMed – as supplied by publisher]
  Related citations
4. Complications and toxicities after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
  Canda AE, Sokmen S, Terzi C, Arslan C, Oztop I, Karabulut B, Ozzeybek D, Sarioglu S, Fuzun M.
  Ann Surg Oncol. 2013 Apr;20(4):1082-7. doi: 10.1245/s10434-012-2853-x. Epub 2013 Mar 2.
  PMID: 23456387 [PubMed – in process]
  Related citations
5. The role of perioperative systemic chemotherapy in diffuse malignant peritoneal mesothelioma patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
  Deraco M, Baratti D, Hutanu I, Bertuli R, Kusamura S.
  Ann Surg Oncol. 2013 Apr;20(4):1093-100. doi: 10.1245/s10434-012-2845-x. Epub 2013 Mar 2.
  PMID: 23456386 [PubMed – in process]
  Related citations
6. Extensive cytoreductive surgery for appendiceal carcinomatosis: morbidity, mortality, and survival.
  Wagner PL, Austin F, Maduekwe U, Mavanur A, Ramalingam L, Jones HL, Holtzman MP, Ahrendt SA, Zureikat AH, Pingpank JF, Zeh HJ, Bartlett DL, Choudry HA.
  Ann Surg Oncol. 2013 Apr;20(4):1056-62. doi: 10.1245/s10434-012-2791-7. Epub 2013 Mar 2.
  PMID: 23456385 [PubMed – in process]
  Related citations
7. Body surface area predicts plasma oxaliplatin and pharmacokinetic advantage in hyperthermic intraoperative intraperitoneal chemotherapy.
  Leinwand JC, Bates GE, Allendorf JD, Chabot JA, Lewin SN, Taub RN.
  Ann Surg Oncol. 2013 Apr;20(4):1101-4. doi: 10.1245/s10434-012-2790-8. Epub 2013 Mar 2.
  PMID: 23456384 [PubMed – in process] Free PMC Article
  Related citations
8. Assessment of neoadjuvant chemotherapy on operative parameters and outcome in patients with peritoneal dissemination from high-grade appendiceal cancer.
  Turner KM, Hanna NN, Zhu Y, Jain A, Kesmodel SB, Switzer RA, Taylor LM, Richard Alexander H Jr.
  Ann Surg Oncol. 2013 Apr;20(4):1068-73. doi: 10.1245/s10434-012-2789-1. Epub 2013 Mar 2.
  PMID: 23456383 [PubMed – in process]
  Related citations
9. Surveillance MR imaging is superior to serum tumor markers for detecting early tumor recurrence in patients with appendiceal cancer treated with surgical cytoreduction and HIPEC.
  Low RN, Barone RM, Lee MJ.
  Ann Surg Oncol. 2013 Apr;20(4):1074-81. doi: 10.1245/s10434-012-2788-2. Epub 2013 Mar 2.
  PMID: 23456382 [PubMed – in process]
  Related citations
10. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in peritoneal carcinomatosis from rectal cancer.
  Votanopoulos KI, Swett K, Blackham AU, Ihemelandu C, Shen P, Stewart JH, Levine EA.
  Ann Surg Oncol. 2013 Apr;20(4):1088-92. doi: 10.1245/s10434-012-2787-3. Epub 2013 Mar 2.
  PMID: 23456381 [PubMed – in process]
  Related citations
11. Hyperthermic intraperitoneal chemotherapy in patients with peritoneal carcinomatosis: role of heat shock proteins and dissecting effects of hyperthermia.
  Pelz JO, Vetterlein M, Grimmig T, Kerscher AG, Moll E, Lazariotou M, Matthes N, Faber M, Germer CT, Waaga-Gasser AM, Gasser M.
  Ann Surg Oncol. 2013 Apr;20(4):1105-13. doi: 10.1245/s10434-012-2784-6. Epub 2013 Mar 2.
  PMID: 23456378 [PubMed – in process]
  Related citations
12. Risk factors for recurrence following complete cytoreductive surgery and HIPEC in colorectal cancer-derived peritoneal surface malignancies.
  Königsrainer I, Horvath P, Struller F, Forkl V, Königsrainer A, Beckert S.
  Langenbecks Arch Surg. 2013 Jun;398(5):745-9. doi: 10.1007/s00423-013-1065-6. Epub 2013 Mar 1.
  PMID: 23456355 [PubMed – in process]
  Related citations
13. Assessment of clinical benefit and quality of life in patients undergoing cytoreduction and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for management of peritoneal metastases.
  Zhu Y, Hanna N, Boutros C, Alexander HR Jr.
  J Gastrointest Oncol. 2013 Mar;4(1):62-71. doi: 10.3978/j.issn.2078-6891.2012.053.
  PMID: 23450068 [PubMed] Free PMC Article
  Related citations
14. Laparoscopic hyperthermic intraperitoneal chemotherapy (HIPEC) for palliative treatment of malignant ascites from gastrointestinal stromal tumours.
  Ong E, Diven C, Abrams A, Lee E, Mahadevan D.
  J Palliat Care. 2012 Winter;28(4):293-6. No abstract available.
  PMID: 23413766 [PubMed – indexed for MEDLINE]
  Related citations
15. A prospective multicenter phase II study evaluating multimodality treatment of patients with peritoneal carcinomatosis arising from appendiceal and colorectal cancer: the COMBATAC trial.
  Glockzin G, Rochon J, Arnold D, Lang SA, Klebl F, Zeman F, Koller M, Schlitt HJ, Piso P.
  BMC Cancer. 2013 Feb 7;13:67. doi: 10.1186/1471-2407-13-67.
  PMID: 23391248 [PubMed – in process] Free PMC Article
  Related citations
16. Heated intraperitoneal chemotherapy in appendiceal cancer treatment.
  Cianos R, Lafever S, Mills N.
  Clin J Oncol Nurs. 2013 Feb;17(1):84-7, 90. doi: 10.1188/13.CJON.84-87.
  PMID: 23372101 [PubMed – in process]
  Related citations
17. Aggressive locoregional management of recurrent peritoneal sarcomatosis.
  Baumgartner JM, Ahrendt SA, Pingpank JF, Holtzman MP, Ramalingam L, Jones HL, Zureikat AH, Zeh HJ 3rd, Bartlett DL, Choudry HA.
  J Surg Oncol. 2013 Mar;107(4):329-34. doi: 10.1002/jso.23232. Epub 2013 Feb 5.
  PMID: 23386388 [PubMed – indexed for MEDLINE]
  Related citations
18. A Phase I Trial of Thermal Sensitization Using Induced Oxidative Stress in the Context of HIPEC.
  Harrison LE, Tiesi G, Razavi R, Wang CC.
  Ann Surg Oncol. 2013 Jun;20(6):1843-50. doi: 10.1245/s10434-013-2874-0. Epub 2013 Jan 26.
  PMID: 23354567 [PubMed – in process]
  Related citations
19. Hyperthermic intraperitoneal chemotherapy with carboplatin for optimally-cytoreduced, recurrent, platinum-sensitive ovarian carcinoma: a pilot study.
  Argenta PA, Sueblinvong T, Geller MA, Jonson AL, Downs LS Jr, Carson LF, Ivy JJ, Judson PL.
  Gynecol Oncol. 2013 Apr;129(1):81-5. doi: 10.1016/j.ygyno.2013.01.010. Epub 2013 Jan 23.
  PMID: 23352917 [PubMed – indexed for MEDLINE]
1. Accuracy of MDCT in the preoperative definition of Peritoneal Cancer Index (PCI) in patients with advanced ovarian cancer who underwent peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC).
  Mazzei MA, Khader L, Cirigliano A, Cioffi Squitieri N, Guerrini S, Forzoni B, Marrelli D, Roviello F, Mazzei FG, Volterrani L.
  Abdom Imaging. 2013 Jun 7. [Epub ahead of print]
  PMID: 23744439 [PubMed – as supplied by publisher]
  Related citations
2. Cytoreductive surgery and intraperitoneal chemotherapy for treatment of peritoneal carcinomatosis from colorectal origin.
  Losa F, Barrios P, Salazar R, Torres-Melero J, Benavides M, Massuti T, Ramos I, Aranda E.
  Clin Transl Oncol. 2013 Jun 6. [Epub ahead of print]
  PMID: 23740133 [PubMed – as supplied by publisher]
  Related citations
3. Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent peritoneal metastases.
  Chua TC, Quinn LE, Zhao J, Morris DL.
  J Surg Oncol. 2013 Jun 5. doi: 10.1002/jso.23356. [Epub ahead of print]
  PMID: 23737041 [PubMed – as supplied by publisher]
  Related citations
4. Importance of standardizing the dose in hyperthermic intraperitoneal chemotherapy (HIPEC): a pharmacodynamic point of view.
  Mas-Fuster MI, Ramon-Lopez A, Nalda-Molina R.
  Cancer Chemother Pharmacol. 2013 Jun 5. [Epub ahead of print] No abstract available.
  PMID: 23736155 [PubMed – as supplied by publisher]
  Related citations
5. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from small bowel adenocarcinoma.
  Sun Y, Shen P, Stewart JH, Russell GB, Levine EA.
  Am Surg. 2013 Jun;79(6):644-8.
  PMID: 23711278 [PubMed – in process]
  Related citations
6. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in peritoneal sarcomatosis.
  Randle RW, Swett KR, Shen P, Stewart JH, Levine EA, Votanopoulos KI.
  Am Surg. 2013 Jun;79(6):620-4.
  PMID: 23711273 [PubMed – in process]
  Related citations
7. Prognostic Factors of Peritoneal Metastases from Colorectal Cancer following Cytoreductive Surgery and Perioperative Chemotherapy.
  Yonemura Y, Canbay E, Ishibashi H.
  ScientificWorldJournal. 2013 Apr 18;2013:978394. doi: 10.1155/2013/978394. Print 2013.
  PMID: 23710154 [PubMed – in process] Free PMC Article
  Related citations
8. Is there a role for intraperitoneal administration of heparin in hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis of colorectal cancer origin? Current data and future orientations.
  Seretis F, Seretis C.
  Med Hypotheses. 2013 May 13. doi:pii: S0306-9877(13)00221-1. 10.1016/j.mehy.2013.04.040. [Epub ahead of print]
  PMID: 23680001 [PubMed – as supplied by publisher]
  Related citations
9. The benefit of intraperitoneal chemotherapy for the treatment of colorectal carcinomatosis.
  Francescutti V, Rivera L, Seshadri M, Kim M, Haslinger M, Camoriano M, Attwood K, Kane JM 3rd, Skitzki JJ.
  Oncol Rep. 2013 Jul;30(1):35-42. doi: 10.3892/or.2013.2473. Epub 2013 May 15.
  PMID: 23673557 [PubMed – in process]
  Related citations
10. Clinical study of cisplatin hyperthermic intraperitoneal perfusion chemotherapy in combination with docetaxel, 5-flourouracil and leucovorin intravenous chemotherapy for the treatment of advanced-stage gastric carcinoma.
  Zhibing W, Qinghua D, Shenglin M, Ke Z, Kan W, Xiadong L, Pengjun Z, Ruzhen Z.
  Hepatogastroenterology. 2013 May 10;60(128). doi: 10.5754/hge13038. [Epub ahead of print]
  PMID: 23598741 [PubMed – as supplied by publisher]
  Related citations
11. Outcome of patients with aggressive pseudomyxoma peritonei treated by cytoreductive surgery and intraperitoneal chemotherapy.
  Arjona-Sanchez A, Muñoz-Casares FC, Casado-Adam A, Sánchez-Hidalgo JM, Ayllon Teran MD, Orti-Rodriguez R, Padial-Aguado AC, Medina-Fernández J, Ortega-Salas R, Pulido-Cortijo G, Gómez-España A, Rufián-Peña S.
  World J Surg. 2013 Jun;37(6):1263-70. doi: 10.1007/s00268-013-2000-2.
  PMID: 23532601 [PubMed – in process]
  Related citations
12. Treatment of peritoneal carcinomatosis from breast cancer by maximal cytoreduction and HIPEC: A preliminary report on 5 cases.
  Cardi M, Sammartino P, Framarino ML, Biacchi D, Cortesi E, Sibio S, Accarpio F, Luciani C, Palazzo A, di Giorgio A.
  Breast. 2013 Mar 21. doi:pii: S0960-9776(13)00053-2. 10.1016/j.breast.2013.02.020. [Epub ahead of print]
  PMID: 23523180 [PubMed – as supplied by publisher]
  Related citations
13. Primary peritoneal serous carcinoma treated by cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy. A multi-institutional study of 36 patients.
  Bakrin N, Gilly FN, Baratti D, Bereder JM, Quenet F, Lorimier G, Mohamed F, Elias D, Glehen O; Association Française de Chirurgie.
  Eur J Surg Oncol. 2013 Mar 16. doi:pii: S0748-7983(13)00263-1. 10.1016/j.ejso.2013.02.018. [Epub ahead of print]
  PMID: 23510853 [PubMed – as supplied by publisher]
  Related citations
14. Impact of hyperthermic intraperitoneal chemotherapy on Hsp27 protein expression in serum of patients with peritoneal carcinomatosis.
  Kepenekian V, Aloy MT, Magné N, Passot G, Armandy E, Decullier E, Sayag-Beaujard A, Gilly FN, Glehen O, Rodriguez-Lafrasse C.
  Cell Stress Chaperones. 2013 Mar 19. [Epub ahead of print]
  PMID: 23508575 [PubMed – as supplied by publisher]
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15. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Asian Patients: 100 Consecutive Patients in a Single Institution.
  Teo MC, Tan GH, Tham CK, Lim C, Soo KC.
  Ann Surg Oncol. 2013 Mar 17. [Epub ahead of print]
  PMID: 23504144 [PubMed – as supplied by publsh
  Related citations
16. Treatment factors associated with long-term survival after cytoreductive surgery and regional chemotherapy for patients with malignant peritoneal mesothelioma.
  Alexander HR Jr, Bartlett DL, Pingpank JF, Libutti SK, Royal R, Hughes MS, Holtzman M, Hanna N, Turner K, Beresneva T, Zhu Y.
  Surgery. 2013 Jun;153(6):779-86. doi: 10.1016/j.surg.2013.01.001. Epub 2013 Mar 13.
  PMID: 23489943 [PubMed – in process]
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17. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy as salvage treatment for a late wound recurrence of endometrial cancer.
  Santeufemia DA, Lumachi F, Basso SM, Tumolo S, Re GL, Capobianco G, Bertozzi S, Pasqual EM.
  Anticancer Res. 2013 Mar;33(3):1041-4.
  PMID: 23482779 [PubMed – indexed for MEDLINE]
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18. Preoperative carcinoembryonic antigen level predicts prognosis in patients with pseudomyxoma peritonei treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
  Canbay E, Ishibashi H, Sako S, Mizumoto A, Hirano M, Ichinose M, Takao N, Yonemura Y.
  World J Surg. 2013 Jun;37(6):1271-6. doi: 10.1007/s00268-013-1988-7.
  PMID: 23467926 [PubMed – in process]
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19. Rhabdomyolysis after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a case report.
  Bielen R, Verswijvel G, Van der Speeten K.
  Case Rep Oncol. 2013 Jan;6(1):36-44. doi: 10.1159/000346471. Epub 2013 Jan 18.
  PMID: 23467441 [PubMed] Free PMC Article

The HIPEC calculator

We’ve talked a lot about HIPEC here – but we have not really talked about the risks of treatment.  While we mentioned the arduous nature of the procedure itself, we’ve left more in-depth discussions to the oncologists.

Now researchers at the National Institute of Health have developed a tool to help clinicians and their patients determine the risks of HIPEC.  In an article published over at Surviving Mesothelioma, the authors discuss their recent study and the results.  Since the procedure itself carries significant mortality – the calculator offers an important tool for determining who the best candidates are for successful treatment with this procedure.

Original Article:

Schaub NP, Alimchandani M, Quezado M, Kalina P, Eberhardt JS, Hughes MS, Beresnev T, Hassan R, Bartlett DL, Libutti SK,Pingpank JF, Royal RE, Kammula US, Pandalai P, Phan GQ, Stojadinovic A, Rudloff U, Alexander HR, Avital I. (2012).  A Novel Nomogram for Peritoneal Mesothelioma Predicts Survival.  Ann Surg Oncol. 2012 Dec 12


Now that Case Western has decided to adopt HIPEC for treatment of gynecological cancers (uterine, ovarian, endometrial etc.) they have published an article patting themselves on the back.. 

But truthfully, not bad, case western, not bad at all.. It’s a good article with a nice explanation for people new to Hyperthermic Intraperitoneal Chemotherapy – (and I am always happy to see more state-of-the-art treatments offered to people with cancer.)

That’s one of the reasons we’ve championed HIPEC here at Bogota Surgery –  state-of-the-art cancer treatment with an excellent track record according to medical literature and published research.  Too often patients, particularly patients with cancer or other serious medical illnesses are preyed upon with junk or uncertain science, like super-vitamin supplement programs, Laetrile clinics and quasi-futuristic stem-cell therapies.

But HIPEC is different, and it’s been here for quite a while  – with over ten years worth of scientific data to support continued experimentation (large-scale) and use.

We first encountered HIPEC in Bogotá at the hands of Dr. Fernando Arias at Fundacion Santa Fe de Bogotá.  In our continued quest for information (see our series on HIPEC) – he continues to be at the forefront of HIPEC treatment with more experience than doctors like Dr. Trey Blazer at Duke, teams at Case Western, and the other scattered programs throughout the United States.  With the exception of its creator, Dr. David Sugarbaker – Dr. Arias has as much experience, evidence and training as anyone I’ve encountered..

See our tab labelled Cytoreductive Surgery for more on HIPEC

The latest HIPEC headlines

More ongoing research trials to validate HIPEC as a potential treatment for ovarian cancer.

The University Hospitals of Cleveland, Ohio recently started several new clinical trials to test the effectiveness of hyperthermic intra-peritoneal chemotherapy  in women with ovarian and endometrial cancer.  Unfortunately, the trials are small (around 60 woman) which means that even positive results will be far from definitive for researchers involved in the HIPEC debate.  It also offers only limited opportunities for patients with ovarian cancer to receive potentially life-saving treatment.

Medpage recently published a nice overview on ovarian cancer and the current treatment modalities – which can be seen here.

More on HIPEC: here at Bogota Surgery:

What is HIPEC? What’s it used for?

Who does HIPEC?

HIPEC updates:

Update #1

HIPEC: the latest research results

If you remember, previous New York Times articles questioned the efficacy of hyperthermic chemotherapy given during cytoreductive surgery.  We promised to investigate, and return with more results to this question.

Recently several articles have been published on the topic, including this one – in the journal of Clinical Oncology.  This narrative by Maurie Markman talks about the quick dismissal of HIPEC by many oncologists, particularly for larger tumors – and he questions the wisdom of this approach in light of recent research results.

In fact, several large new American studies – including one at Case Western are examining the use of HIPEC, particularly in gynecological cancers like ovarian and uterine cancers which carry a dismal prognosis.

American Hospitals are finally jumping on the HIPEC bandwagon…

Detroit hospital offering HIPEC

Atlanta docs, robots and HIPEC

This last link isn’t really news – it’s a press release, but since it’s on a surgical oncologist (Dr. Wilbur Bowne) who was an early American adopter of HIPEC, I thought readers might be interested.

Previous Bogota Surgery posts on HIPEC

HIPEC: The basics

Bogota Surgeons stay ahead of the curve

The Future is Now: HIPEC

Looks like it’s about time to check in with our favorite surgical oncologist, and HIPEC expert, Dr. Fernando Arias..

Check back soon for more..

HIPEC in the news again..

Another story about bringing HIPEC to the masses – this time in Mumbai, India..  I have to wonder about the research for the article – everytime I see the phrase, “A ray of hope”..  sounds suspiciously like the original title of a certain article (in Colombia Reports.com) all of us are familiar with over here at Bogota Surgery.org.

HIPEC and peritoneal mesothelioma – more effective in women?

New article on HIPEC

There’s a new article on the HIPEC procedure that’s a nice read for people interested in this procedure.  The article is unrelated to medical tourism – it’s about the first application of hyperthermic intraperitoneal chemotherapy at a private facility in India.  (As you can imagine – I wouldn’t recommend that anyone have a procedure at a facility where doctors have just started trialling the technique.) That being said – the article gives a nice overview of the procedure itself.

Back to Bogota

Raleigh – Durham Airport (RDU) – A more personal post today for readers –

The nice thing about traveling to Colombia is that even though the distances are pretty far geographically, flight times are pretty short.  After a one hour flight to Miami, it’s just three short hours to Bogotá.  Despite that – Bogotá is certainly a world away from my quiet life in Virginia.

– Now I am here in the airport, beginning my journey back to Colombia, starting with a week in Bogotá, my favorite of all Colombian cities (so far!)  My adoration of Bogotá came as quite of a surprise to me – and still surprises me after all these months.  I’d enjoyed Cartagena – that beautiful, historic but steamy coastal city, but I expected that.  It has architecture, museums, monuments along with the ocean, and a latin-caribbean feeling that I like so much.  Anyone can love Cartagena with its elegant fortresses, warm sunny weather and welcoming residents.  No – Bogota is different.  It’s high mountain elevation (8000 ft) gives it a unique climate (eternal fall) with distinct rainy seasons. The city sprawl extends the entire basin of the foot of the mountains – the city itself is surrounded by a haze mix of cloud, smog/ pollution from its inhabitants..

No, my enjoyment of Bogotá was a complete surprise.  I had expected to tolerate the city, to endure the bustle, rush, the traffic and the very condensed humanity that is a city of ten million people.  It was, in my mind, a necessary evil as part of my research for writing the book.  I am many things, but a city girl?  Not hardly.  A more rustic/ rural / redneck gal could not be found, in northern Nevada, West Virginia and now, in the smallest of urban cities, a mere hamlet of southern Virgina.  I expected to be intimidated by the sheer volume of people; after all, I hate crowds, and busy public places. But somehow, it was the complete opposite – it was invigorating, intoxicating.

The very sophistication, the people, the life of the city was addicting in a way I never expected.  As three months turned to four, and then five – I kept expecting for my love affair with the city to fade or flame out.  But it hasn’t, and I am already mourning my return to the USA.

In Bogota Surgery news:

The New York Times has recently published an article talking about the HIPEC procedure as “bringing hope to patients**”.  In typical media fashion, they manage to interview the one surgeon who talks about the procedure in an exceedingly cavalier fashion – and the author of the article reinforces this with his terminology (which I find disturbing.)   Did he really need to describe the surgery thusly:

“After slicing the man’s belly wide open, he thrust his gloved hands deep inside, and examined various organs, looking for tumors. He then lifted the small intestine out of the body to sift it through his fingers.

As he found tumors, he snipped them out. “You can see how this is coming off like wallpaper,” Dr. Lowy said as he stripped out part of the lining of the man’s abdominal cavity.

After about two hours of poking and cutting, Dr. Lowy began the so-called shake and bake. The machine pumped heated chemotherapy directly into the abdominal cavity for 90 minutes while nurses gently jiggled the man’s bloated belly to disperse the drug to every nook and cranny. ”

Blatent sensationalism in my opinion – certainly guaranteed to sell papers.  If they terrorize a few patients in the process, I guess they don’t care..  Using patient friendly terminology doesn’t mean writing an article like a Stephen King novel..  But then – I am guessing that Andrew Pollack has never had a close family member or friend facing this sort of illness.

The author also does a poor job researching his sources or the actual clinical indications for the procedure, but Bogota Surgery readers will be interested to note the cost of the procedure in the USA ranges from 20,000 to 100,000 – which certainly provides plenty of incentive for medical tourism.

However, despite this fantastic language – the authors voice serious concerns about the effectiveness and appropriateness of this procedure.  As you know, I have been following the available research and will continue to do so – to bring readers more information about this procedure; it’s feasibility and effectiveness.

** Since publishing my initial article on HIPEC with hope in the title, there have been a spate of articles using that terminology, as well as several blatent rip-offs of my original article.  The success of this article has been surprising, as well as the level of plagerism with on-line media, including large, well-known media outlets.

Bogota Surgery and the International Medical Travel Journal

Thanks to the eagle-eyed reader who notified me that portions of one of my articles “Bogotá hospital offers hope to abdominal cancer patients” (originally published on Colombia Reports.com) was featured in the article, “Agencies promote Central and Southern American medical tourism.”

I’ve asked them to provide a link to the original article so readers can get more information on the topic.

Update: 29 June 2011: Here’s a link to the new article on Treatment Abroad (which is an International Medical Travel Journal sister site) that gives their readers the information they really need. (The name of the doctor, of course!)  It’s a summary of the original Colombia Reports.com article. They still haven’t cited the ‘borrowed’ content on the original article, or provided the name of the physician doing the treatment (Dr. Fernando Arias) but I guess it’s an improvement.

The Future is Now – HIPEC in the news again..

Another article on the effectiveness of HIPEC (cytoreductive surgery with intraoperative hyperthermic chemotherapy) in the news.  This story comes out of India and highlights doctors there and the HIPEC procedure for treatment of abdominal cancers (intestinal and ovarian cancers.)

The Future is Now..  in an article on Medscape, dated December of 2010 and originally published in Future Oncology, Dr. Ze Lu et. al discusses the future of cancer treatment.  (The article is several pages in length – so I haven’t re-posted but reference information is provided below).  Dr. Ze Lu and his colleagues believe the future of oncology treatment is…. Intraperitoneal Hyperthermic Chemotherapy (HIPEC)..

In August, we’ll check back in with Bogotá’s resident expert on HIPEC, Dr. Fernando Arias.


Lu, Z., Wang, J.,  Wientjes, G., & Au, J. (2010).  Intraperitoneal therapy for peritoneal cancer.  Future Oncology. 2010 (6) 10; 1625 -1641

Bogota surgeons stay ahead of the curve

As we’ve seen several times before, Bogotá surgeons stay ahead of the curve on cutting edge treatments.  In the last several weeks, HIPEC or Hyperthermic intraperitoneal chemotherapy (Sugarbaker procedure) has been dotting the news headlines in the United States, and across the globe.

But as my readers here at Bogotá Surgery know, not only have we talked about HIPEC in the past – Dr. Arias has been performing this procedure at Fundacion Santa Fe de Bogota since 2009.  He reports he did eight cases in May alone.  (This is considered fairly high volume if you review the amount of cases being done at other centers.)

Planning to catch up with Dr. Arias and check in later this summer..

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

I’ve been wanting to write more on this topic since I initially discussed it with Dr. Fernando Arias, MD but first, I had to educate myself more on the topic, before I could present it here. After some additional reading, and lots of additional questions for Dr. Arias – here we go…

When I first heard about this treatment being offered here in Bogota – I knew I had to tell you all about it: since this treatment is used to treat patients that are otherwise out of options.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) is used to treat patients with advanced abdominal cancers such as digestive or gynecological cancers that have spread inside the peritoneum (abdominal cavity). In many cases, these patients would otherwise receive either standard chemotherapy (not very effective) or palliative treatment only at this point – and had a very dismal** prognosis.
Now obviously, this isn’t some sort of miracle cure for everybody, and it isn’t easy, or complication-free – in fact, it is an intensive, radical approach with serious side effects, and potentially lethal complications
but it is a chance to try and aggressively pursue treatment for patients who would otherwise have little or no hope.

Some of the long term data have been very encouraging, showing significant five year survival benefits, but some of the reseach doesn’t. Some of the long term data is marred by changing techniques, administration and chemotherapy dosing.. A lot of the research, such as the Dutch trial showing 8 year follow up is plagued by small sample sizes, which limits our ability to draw strong conclusions about therapy. However, in a few of the articles I reviewed, the “c” word (Cure) was used selectively.

This treatment has been around for about ten years, but it isn’t widely available. It’s only offered at about 14 centers in the USA, a few in Europe and three in Latin America (one being here in Bogota).

So what is it? HIPEC or the short hand for this complex mouthful is surgery (laparoscopic surgery here in Bogota) to remove all visible of cancer tissue, while infusing HOT (hyperthermic) chenotherapy to kill all the cancer cells that are microscopic or not visible to the naked eye in surgery. The advantage of instilling chemotherapy right into the abdomen is that treatment is directed at the site of the disease. The warm solution promotes more effectively killing of cancer cells, and by combining surgery with chemotherapy, doctors are able to treat more advanced cancers with more effective treatment modalities (in cancer-speak: being able to surgically remove cancer is always more effective that treating it with drugs, but with standard treatments doctors could only treat limited disease (disease that had not spread). It sounds pretty simple, but it’s actually a fairly complex, drawn out process that takes multiple, multiple hours in the operating room and requires patients to be hospitalized for at least a week.

So far, Dr. Arias, and the oncologist he works with (sorry, I am blanking on the spelling of his name) started a program to offer this treatment in Bogota in 2009. Since then, they have performed over 30 cases (which if you look at the research, you’ll see is actually a fairly large number) since then.

** ‘dismal’ and ‘very dismal’ is not my editorializing; this language was used in several of the articles I read.

I’ve included some references for more information on this treatment for my readers, at the bottom of the page.

Additional References: (links to original research articles)

1. If you are only going to read one article; read this french one (in english) called:Hyperthermic Intraperitoneal Chemotherapy in Advanced
Gastric Cancer: The End of Skepticism?
It gives a good overview of WHO benefits from this treatment in regards to patients with gastric cancers.

2. Ten year’s experience of Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy – San Guiseppe Hospital, Italy

3. Hyperthermic Intraperitoneal Chemotherapy – this is a technical article that explains the rationale of treatment, and the actual methods of treatment with discussion for other medical personnel.

4. A very small Dutch trial with 8 year outcomes