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]
  Related citations
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]
  Related citations
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]
  Related citations
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]
  Related citations
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

Dr. Gabriel Ramos, Oncology Surgeon

Dr. Gabriel Ramos, Oncologic Surgeon

Been a busy week  – (Yea!) but now that it is the weekend, I have a chance to post some more pictures and talk about my day in the operating room with Dr. Gabriel Omar Ramos Orozco. 

Despite living in a neighboring apartment, interviewing Dr. Ramos proved to be more difficult than anticipated.  But after several weeks, I was able to catch up with the busy surgeon.

Outside of the operating room, he is a brash, young surgeon with an off-beat charm and quirky sense of humor.  But inside the operating room, as he removes a large tumor with several cancerous implants, Dr. Gabriel Ramos Orozco is all business.

It’s different for me, as the interviewer to have this perspective.  As much as I enjoy him as a friendly neighbor – it’s the serious surgeon that I prefer.  It’s a side of him that is unexpected, and what finally wins me over.

Originally from San Luis Rio Colorado in the neighboring state of Sonora, Dr. Ramos now calls Mexicali home.  Like most surgeons here, he has a staff position at a public hospital separate from his private practice.  It is here at IMSS (Instituto Mexicano del Seguro Social) where Dr. Ramos operates on several patients during part of the extended interview.

Operating room nurses at IMSS

During the cases, the patients received a combination of epidural analgesia and conscious sedation.  While the anesthesiologist was not particularly involved or attentive to the patients during the cases, there was no intra-operative hypotension/ alterations in hemodynamic status or prolonged hypoxia.

Dr. Ramos reviewed patient films and medical charts prior to the procedures.  Patients were prepped, positioned and draped appropriately.  Surgical sterility was maintained during the cases.  The first case is a fairly straight forward laparoscopic case – and everything proceeds rapidly, in an uncomplicated fashion.  45 minutes later, and the procedure is over – and Dr. Ramos is typing his operative note.

Dr. Gabriel Ramos in the operating room

But the second case is not – and Dr. Ramos knows it going in..

The case is an extensive tumor resection, where Dr. Ramos painstakingly removes several areas of implants (or tumor tissue that has spread throughout the abdomen, separate from the original tumor).

The difference between being able to surgical remove all of the sites and being unable to remove all of the gross disease is the difference between a possible surgical ‘cure’ and a ‘de-bulking’ procedure, Dr. Ramos explains.  As always, when entering these surgeries, Dr. Ramos and his team do everything possible to go for surgical eradication of disease.  The patient will still need adjunctive therapy (chemotherapy) to treat any microscopic cancer cells, but the prognosis is better than in cases where gross disease is left behind*.  During this surgery, after extended exploration – it looks like Dr. Ramos was able to get everything.

“It’s not pretty,” he admits, “but in these types of cases, aesthetics are the last priority,” [behind removing all the tumor].  Despite that – the aesthetics after this large surgery are not as worrisome as one might have imagined.

The patient will have a large abdominal scar – but nothing that differs from most surgical scars in the pre-laparoscopy era.  [I admit I may be jaded in this respect after seeing so many surgeries] – It is several inches long, but there are no obvious defects, the scar is straight and neatly aligned at the conclusion of the case – and the umbilicus “belly-button” was spared.

after the successful removal of a large tumor

As I walk out of the hospital into the 95 degree heat at 11 o’clock at night – I admit surprise and revise my opinion of Dr. Ramos – he is better than I expected, (he is more than just the kid next door), and he deserves credit for such.

*This may happen due to the location of metastatic lesions – not all lesions are surgically removable.  (Tumor tissue may attach to major blood vessels such as the abdominal aorta, or other tissue that cannot be removed without seriously compromising the patient.)  In those cases, surgeons try to remove as much disease as possible – called ‘de-bulking’ knowing that they will have to leave tumor behind.

New Article at Colombia Reports

Read my latest article at Colombia Reports.com:

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

Dr. Santos, almost Dr. Hoyos and Dr. Castro

Full day today – met with Dr. Hernando Santos at Clinica Shaio – and I’ll be heading to the OR with him on Monday..

 Dr. Hoyos – he was in surgery when I arrived for our appointment, so I’ll try again soon..

Spent the evening with Dr. (Jose) Felix Castro, a very nice general surgeon, on staff at Clinica del Country.. Followed him to the OR for a case –