Essential Questions to ask if you or a loved one has been diagnosed with Mesothelioma ***IMPORTANT***

Closed-Abdominal HIPEC vs Open-Abdominal HIPEC

Posted on: October 14, 2023 *Updated on: May 27, 2024

Hyperthermic intraperitoneal chemotherapy (HIPEC) is a specialized treatment for selected patients with certain types of abdominal cancer. The treatment involves delivering heated chemotherapy directly to the cancerous cells in the abdominal cavity. Both the closed-abdominal and open-abdominal techniques have their pros and cons. Here’s a more detailed comparison between the two:

1. Closed-Abdominal HIPEC:

  • Advantages:
    • Heat Containment: Since the abdominal cavity is closed, the heat from the chemotherapy solution is retained more effectively, which can enhance the cytotoxic effect on the cancer cells.
    • Reduced Drug Spillage: The closed method minimizes the risk of chemotherapy leakage outside the abdominal cavity, thereby potentially decreasing the risk to healthcare personnel.
    • Tumor Penetration: The closed pressure system might provide better penetration of the chemotherapy into the tumor nodules.
  • Disadvantages:
    • Distribution Challenges: Ensuring even distribution of the chemotherapy drug throughout the entire abdominal cavity can be difficult. There’s a potential risk of certain areas not getting adequate exposure to the chemotherapy solution.

2. Open-Abdominal HIPEC (also known as the “coliseum technique”):

  • Advantages:
    • Optimal Drug Distribution: The surgeon can manually stir the chemotherapy solution to ensure that it reaches every nook and cranny of the abdominal cavity. This technique is especially valuable when there are complex adhesions or difficult anatomy.
  • Disadvantages:
    • Heat Loss: The open nature of this method may lead to some loss of heat, potentially reducing the effectiveness of the treatment.
    • Exposure Risk: There is a greater risk of chemotherapy exposure to the operating room staff because the abdomen is open. This mandates strict adherence to safety protocols to protect the medical team.
    • Longer Exposure for Surgeon: The surgeon and operating team are exposed for a longer duration due to the need to constantly agitate the solution for even distribution.

In conclusion, the choice between closed and open HIPEC often depends on various factors including the surgeon’s expertise, the patient’s specific anatomy, the extent and distribution of disease within the abdomen, and the specific goals of the procedure. Both techniques have their unique advantages, and both can be effective in the right context. As with any medical procedure, the benefits and risks should be thoroughly discussed with a medical team before deciding on the best approach.