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Cytoreductive Surgery With HIPEC for Peritoneal Mesothelioma

Cytoreductive surgery with heated chemotherapy (HIPEC) combines surgery with a warm chemotherapy bath to treat peritoneal mesothelioma. More than two-thirds of patients will still be alive five years after receiving this treatment. Mesothelioma Hope can help you find a mesothelioma specialist who performs cytoreductive surgery with HIPEC.

Medically reviewed by: Mark Levin, MD

Last updated:

What Is Cytoreductive Surgery With HIPEC?

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) is a type of surgery for patients with peritoneal mesothelioma.

This two-part peritoneal mesothelioma surgery involves:

  1. Removing visible tumors from the abdomen
  2. Bathing the abdominal cavity in heated chemotherapy to kill remaining cancer cells

Cytoreductive surgery with HIPEC is an effective treatment that can improve peritoneal mesothelioma patients’ length and quality of life. In fact, it’s still the gold standard in treating this cancer more than 40 years after Dr. Paul Sugarbaker helped develop it.

More than 69% of patients are still alive 5 years after receiving cytoreductive surgery with HIPEC, according to the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center.

Some patients experience long remissions after cytoreduction and HIPEC. This means their cancer is not growing or spreading.

Find specialists who perform cytoreductive surgery with HIPEC using our Free Doctor Match.

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Mesothelioma Cytoreduction With HIPEC Procedure

A mesothelioma doctor with expertise in surgical oncology performs the cytoreduction with HIPEC procedure while the patient is under general anesthesia.

The entire surgery can take anywhere from 4-10 hours, depending on how far the cancer has spread and other factors.

Learn more about this surgical treatment for mesothelioma cancer below.

Phase 1: Cytoreductive Surgery

During the first phase of HIPEC cytoreductive surgery, a mesothelioma doctor surgically removes all visible tumors and diseased tissue from the abdomen in a process called tumor debulking.

To do this, the surgeon makes an incision that extends from the bottom of the sternum (breast bone) to the top of the pubic bone.

The surgeon may need to perform a resection (removal of organs or parts of organs) to rid the area of tumors.

The two steps of cytoreduction surgery with HIPEC are shown in an illustration.
Illustration showing the two-part cytoreductive surgery with HIPEC procedure

Phase 2: Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

After the surgery is complete, the chemotherapy is administered. This process takes 1-2 hours.

The HIPEC procedure involves the following steps:

  1. The surgeon inserts a catheter (flexible tube) into an incision in the abdomen.
  2. The catheter is connected to a machine that heats the chemotherapy to 108°F and pumps it inside the body. The cytoreductive chemotherapy solution is heated to 108°F as cancer cells die at about 104°F and healthy cells die at about 111.2°F.
  3. The surgeon may gently rock the patient’s body so the chemotherapy reaches all areas of the abdominal cavity.
  4. After the treatment is complete, the doctor drains the chemotherapy drugs from the cavity and rinses it with a saline solution.
  5. The surgeon closes any open incisions.

The main goal of HIPEC treatment is to rid the affected area of any remaining mesothelioma cancer cells. This minimizes the chance of new tumors growing from cells the naked eye can’t see.

The high temperature causes blood vessels to expand and allows the chemotherapy drugs to go deeper and eliminate cancerous cells. In addition, the chemotherapy stays in the abdomen where it’s needed.

As 90% of the chemotherapy stays in the abdominal cavity, patients have less serious side effects than those who receive intravenous chemotherapy.

A mesothelioma doctor can confirm if you’re a candidate for cytoreductive surgery with HIPEC.

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What Is the Life Expectancy After HIPEC Surgery?

Many mesothelioma patients are able to live for years after undergoing cytoreductive surgery with HIPEC.

A study published in Cancer Management and Research reported that patients who got this treatment had an average life expectancy of 53 months — or nearly 4.5 years.

In 2022, the Washington Cancer Institute reported that about 80% of patients lived 5 years or more if they received additional chemotherapy after undergoing cytoreduction with HIPEC.

Keep in mind that these numbers are estimates and that each person’s case is unique. Many patients have lived for a decade or more with the help of mesothelioma treatments and the support of their family and friends.

Alexis Kidd
Point of Hope

Houston resident Alexis Kidd was diagnosed with peritoneal mesothelioma in 2007 and underwent cytoreductive surgery with HIPEC. More than 16 years later, Alexis is still thriving and inspiring others who are battling this rare cancer.

You can read more about Alexis and other mesothelioma patients who beat the odds in our Free Survivors Guide, shipped free overnight.

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Cytoreductive Surgery With HIPEC Risks and Side Effects

Cytoreductive surgery is an effective mesothelioma treatment that can add years to a patient’s life, but as with any operation, comes with its share of risks. Patients may experience postoperative complications that can impact their recovery.

A mesothelioma doctor and his patient discuss cytoreductive surgery with HIPEC

Health risks include:

  • Blood clots
  • Fistula (abnormal connections between organs)
  • Gastrointestinal problems
  • Heart failure
  • Infection
  • Internal bleeding
  • Death

Patients may also have side effects from both the surgical procedure and chemo.

Common side effects include:

  • Abdominal pain
  • Bloating
  • Constipation
  • Depression
  • Diarrhea
  • Fatigue
  • Insomnia
  • Loss of appetite and weight
  • Nausea and vomiting
  • Temporary loss of bowel function

Even though some of these side effects can be serious, they tend to decrease as the patient recovers.

A mesothelioma doctor can tell you if you’re a candidate for cytoreductive surgery and explain the risks and side effects. Use our Free Doctor Match or call our Patient Advocates at (866) 608-8933 to find a specialist in your area.

Cytoreductive Surgery With HIPEC Recovery

Patients can expect to spend 1-3 months recovering from cytoreduction with HIPEC. However, it may take up to a year for them to feel like they did before this cancer treatment.

Patients typically spend 5-7 days in a hospital or mesothelioma cancer center after their surgery. Sometimes, patients may need to get nutrition through a feeding tube while they recover.

Upon discharge, patients should be able to walk and eat food by mouth, and pain from the surgery should be under control.

Once home, patients may feel tired for several months. While it’s essential for patients to rest, they should also get up and move to fight fatigue and prevent complications like blood clots in the legs and pneumonia.

“Patients should continue doing the things they enjoy and set goals throughout their recovery.”
– Tufts Medical Center

Proper diet and nutrition can also help patients heal from cytoreduction and HIPEC. Most cancer centers have dieticians who work with patients and their families.

Patients should expect to have a follow-up appointment with their doctor 1 to 2 weeks after discharge and then regular follow-up appointments and lab work moving forward.

Find Doctors for Mesothelioma Cytoreduction With HIPEC

Cytoreductive surgery with HIPEC is considered the premier standard of care for treating patients with peritoneal mesothelioma.

The procedure has allowed many patients to live long, fulfilling lives and has given them more time to spend with the people they love.

Mesothelioma Hope can connect you with specialists who perform cytoreductive surgery with HIPEC and even help schedule your first appointment.

Find a mesothelioma doctor today and see if you may benefit from this life-extending procedure.

Mesothelioma Cytoreduction With HIPEC FAQs

What is CRS and HIPEC surgery?

CRS and HIPEC are two components of a combined surgical procedure used to treat peritoneal mesothelioma and other abdominal cancers.

  1. Cytoreductive surgery (CRS) involves removing visible tumors and cancerous tissue from the abdominal cavity. Doctors may also remove affected organs or tissues, such as parts of the peritoneum (abdominal lining), organs like the colon or spleen, and any other areas where cancer has spread.
  2. Hyperthermic intraperitoneal chemotherapy (HIPEC) is a technique used during surgery to deliver heated chemotherapy directly into the abdominal cavity to destroy any remaining cancer cells that may not have been visible or accessible during CRS.

What is the success rate of cytoreductive surgery with HIPEC?

Cytoreductive surgery with HIPEC is very successful in many cases. Recent data shows it increases overall survival rates in peritoneal mesothelioma cancer patients by 50-90%.

Further, patients who got the treatment had an overall life expectancy of 53 months on average, according to a study published in Cancer Management and Research.

What is the survival rate for HIPEC surgery?

Survival rate is the percentage of patients who will still be alive after a certain length of time following their diagnosis.

Today, 69% of patients who undergo cytoreductive surgery with HIPEC are still alive after 5 years, according to University of Maryland Medical Center.

How long does it take to recover from cytoreductive surgery and HIPEC?

On average, patients can expect to spend 1-3 months recovering from HIPEC cytoreductive surgery. This includes a hospital stay of about 1 week and then the rest of the time spent healing at home.

While patients typically feel better a few months after mesothelioma surgery, it may take them up to a year to feel back to normal. Of course, every patient is different and may face unique health challenges. For this reason, patients should consult with their doctors about recovery times.

What is the most common complication of cytoreductive surgery?

The most common complications of cytoreductive surgery are bleeding and infection. Your medical team will address any complications that may arise as you recover.

What are the long-term side effects of HIPEC?

Long-term side effects of cytoreductive surgery with HIPEC include:

  • Diarrhea
  • Constipation
  • Insomnia
  • Fatigue
  • Trouble breathing

Your health care provider can help you manage long-term symptoms.

Dr. Mark LevinReviewed by:Mark Levin, MD

Certified Oncologist and Hematologist

  • Fact-Checked
  • Editor

Mark Levin, MD, has over 30 years of experience in academic and community hematology and oncology. In addition to serving as Chief or Director at four different teaching institutions throughout his life, he is still a practicing clinician, has taught and designed formal education programs, and has authored numerous publications in various fields related to hematology and oncology.

Dr. Mark Levin is an independently paid medical reviewer.

  • Board Certified Oncologist
  • 30+ Years Experience
  • Published Medical Author
Jenna TozziWritten by:

Director of Patient Advocacy

Jenna Tozzi, RN, is the Director of Patient Advocacy at Mesothelioma Hope. With more than 15 years of experience as an adult and pediatric oncology nurse navigator, Jenna provides exceptional guidance and support to mesothelioma patients and their loved ones. Jenna has been featured in Oncology Nursing News and is a member of the Academy of Oncology Nurse & Patient Navigators & the American Nurses Association.

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  1. Cleveland Clinic. (2023, September 19). Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Retrieved February 8, 2024, from
  2. Trial of Cytoreductive Surgery and HIPEC in Patients With Primary and Secondary Peritoneal Cancers. Retrieved February 8, 2024, from
  3. JAMA Network. Morbidity and Mortality Rates Following Cytoreductive Surgery Combined With Hyperthermic Intraperitoneal Chemotherapy Compared With Other High-Risk Surgical Oncology Procedures. Retrieved February 8, 2024, from
  4. Mayo Clinic. Cytoreductive surgery and HIPEC offers effective treatment for selected patients with peritoneal carcinomatosis. Retrieved February 8, 2024, from
  5. Pleura Peritoneum. Update of randomized controlled trials evaluating cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in prevention and therapy of peritoneal metastasis: a systematic review. Retrieved February 8, 2024, from
  6. Rouhi, A.D., Choudhury, R.A., Hoeltzel, G.D. et al. Delayed CRS-HIPEC Is Associated with Decreased Survival in Patients with Malignant Peritoneal Mesothelioma: A Markov Decision Analysis. Journal of Gastrointestinal Surgery (2022, November 28). Retrieved February 8, 2024, from
  7. Springer. Repeat Cytoreductive Surgery and Heated Intraperitoneal Chemotherapy May Offer Survival Benefit for Intraperitoneal Mesothelioma: A Single Institution Experience. Retrieved February 8, 2024, from
  8. Tufts Medicine. (n.d.). HIPEC FAQs. Retrieved February 8, 2024, from
  9. Tufts Medicine. (n.d.). HIPEC Surgery – What to Expect. Retrieved February 8, 2024, from
  10. UChicago Medicine. (n.d.). “Hyperthermic Intraperitoneal Chemotherapy (HIPEC).” Retrieved February 8, 2024, from
  11. University of Maryland, Marlene and Stewart Greenebaum Comprehensive Cancer Center. (n.d.). Cytoreductive Surgery and HIPEC – FAQs. Retrieved February 8, 2024, from
  13. World Journal of Surgical Oncology. Cytoreduction and HIPEC in the treatment of “unconventional” secondary peritoneal carcinomatosis. Retrieved February 8, 2024, from
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