VIAMED INSTITUTE OF
ADVANCED SURGICAL ONCOLOGY

HIPEC

What would cytoreductive surgery and HIPEC involve?

Cytoreductive surgery is a comprehensive and meticulous type of surgery, in which we examine the entire abdomen inch by inch to remove all tumour nodules from the peritoneum. It involves a combination of peritonectomy (removal of the peritoneum) and other organs to remove all visible disease from the abdomen. This procedure can be performed via conventional open surgery or through a minimally invasive approach, by laparoscopy.

HIPEC. Cirugía de citorreducción

What role does HIPEC play in the treatment of peritoneal carcinomatosis?

HIPEC stands for hyperthermal intraperitoneal chemotherapy. It is a treatment for patients with advanced cancer that has spread throughout the peritoneum. This treatment aims to kill the tumour and prolong the patient’s survival.

It consists of administering chemotherapy at a temperature between 40-43ºC for between 60-120 minutes at the end of the cytoreduction surgery procedure.

This procedure is completed with a dose of warm chemotherapy, administered as an infusion, which is removed from the abdomen at the end of the procedure. The goal is to eliminate microscopic disease, eliminating any tumour cells that may be loose in the abdomen after surgery with that dose of chemotherapy.

Which patients can be treated using cytoreductive surgery and HIPEC?

It is a curative treatment for patients with advanced cancer that has spread to the peritoneum. This is known as peritoneal carcinomatosis or peritoneal metastases.

The primary tumour may be located:

In the abdomen

Stomach, colon, small intestine, ovary, pancreas, endometrium, appendix (one of its variants is peritoneal pseudomyxoma), sarcoma, cholangiocarcinoma, kidney cancer.

Outside the abdomen

Lung cancer, breast cancer, melanoma.

In the peritoneum itself

Peritoneal mesothelioma, primary peritoneal cancer.

Are all patients with peritoneal carcinomatosis candidates for treatment with cytoreductive surgery and HIPEC?

The aim of cytoreductive surgery or peritonectomy and HIPEC is curative. To explain which patients are candidates for this treatment we must first understand what PCI (peritoneal cancer index) means.

PCI is the amount of tumour inside the abdomen. It is an index that indicates the degree of disease, and which is very important for surgical oncologists, since it tells us a lot about the patient’s prognosis and the best treatment sequence for each individual. It is a number between 0 and 39, calculated by dividing the abdomen into 12 regions and assigning a score of 0 to 3 according to the number of peritoneal implants and the size at that location.

How is peritoneal carcinomatosis treated?

Currently, treatments for peritoneal carcinomatosis remain limited and have a conservative prognosis.

Standard palliative chemotherapy often provides only modest improvement in prognosis with low tumour response rates. In addition, this treatment is associated with a significant risk of harmful side effects.

Multimodal management combining systemic chemotherapy, complete cytoreductive surgery, which can be combined with the administration of hot intraperitoneal chemotherapy (HIPEC), is an effective alternative for patients where spread of the disease is limited and does not affect areas known to be unresectable (for example when the disease has spread to a large area of the small intestine, the liver hilum…). This surgery, with or without HIPEC, can be performed in our facility using conventional open surgery, but for selected patients we also offer the possibility of performing this surgery through minimally invasive means (laparoscopy).

Can this treatment be performed using minimally invasive techniques?

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Depending on the origin of the primary tumour and the PCI, we can offer treatment with cytoreductive surgery and HIPEC in the following scenarios:

– Peritoneal metastases of gastric origin: PCI less than or equal to 9

– Peritoneal metastases originating in colon cancer: PCI less than or equal to 17

– Peritoneal metastases originating in cancer of the appendix, the ovaries, primary peritoneal, mesothelioma peritoneal, pseudomyxoma… In these cases we are not limited by the PCI, provided that the whole disease is operable, we can offer cytoreductive surgery and HIPEC

It depends on many factors, but usually between 7 and 20 days. The first 24 – 48 hours are usually spent in the ICU for close monitoring, although the patient is awake, carrying out physical and respiratory rehabilitation exercises… and later on the ward, until they are in a fit state to return home, where they will continue with their postoperative recovery programme at home.

The performance of this surgery by expert teams and in accordance with a pre-operative prehabilitation and ERAS programme (early postoperative recovery) are important to reduce complications or their impact. After this surgery, complications can appear from major abdominal surgery such as infection, bleeding, anastomotic leak, respiratory and urinary tract infections… and complications derived from chemotherapy (such as a drop in white blood cells, platelets, impaired renal function)… At IVOQA, our protocols seek to reduce these complications and to detect them early.complicaciones, así como una detección precoz de las mismas.

This is a complex case but one we see frequently in our consultations. Unfortunately, in many facilities, these patients are offered palliative care only. We have many years of experience treating patients with metastases in several sites, requiring a thorough study by the tumours committee. We always begin with intravenous chemotherapy and, depending on how the cancer responds, we evaluate whether to take a radical approach to remove the whole disease in accordance with very strict parameters

All patients with peritoneal disease should be evaluated in a peritoneal surgery unit, by a committee of experts in peritoneal pathology, even patients with liver metastases, inoperable disease and high PCI, since we now have multiple treatment options for all of them

What about patients with a high PCI or unresectable disease and/or non-response, or disease progression despite systemic chemotherapy?

In these cases, PIPAC can be a great alternative

Do not hesitate to request an appointment with our specialists

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HOSPITAL VIAMED SANTA ELENA phone: 914 53 94 00 C/La Granja, 8 28003 Madrid Metro: Vicente Aleixandre (Línea 6) Guzmán el Bueno (linea 6 y 7)

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Dr. Javier Heras

BREAST UNIT

  • Graduate in Medicine and Surgery from Universidad Autonoma de Madrid 1992.
  • Specialist via MIR in Family Medicine at Hospital Universitario Ramón y Cajal 1994-1996.
  • Specialist via MIR in OBSTETRICS AND GYNECOLOGY at Hospital Universitario Santa Cristina in Madrid 1997-2001.
  • Specialized in the last 27 years in Gynecological Oncology and Breast Pathology, both malignant and benign, with experience in Oncoplastic Surgery.
  • Specialization Course in Oncoplastic Breast Surgery 2015.
  • Coordinator of the Breast Unit and the Breast Tumors and Gynecology Oncology Committee in Hospital Universitario Infanta Sofía.
  • Main Author of the Breast Unit Accreditation Project (Hospital Universitario Infanta Sofía) 2019-2020.

Dr. Beatriz García-Conde

DIGESTIVE SYSTEM MEDICINE

  • Graduate in Medicine and Surgery.
  • MIR specialisation in Digestive System Medicine, Puerta de Hierro University Hospital in Majadahonda. Currently working at the 12 de Octubre University Hospital.
  • Specialist in capsule endoscopy and in diagnostic and therapeutic endoscopy: chromoendoscopy, colon cancer screening, digestive dilatations, PEG placement, endoluminal vacuum therapy (fistulas/leaks), polypectomy/mucosectomy.
  • She also a general digestive consultant with a Master’s Degree in Neurogastroenterology.

Dr. Micaela Riat Castro Zocchi

DIGESTIVE SYSTEM MEDICINE

  • Graduate in Medicine and Surgery.
  • MIR specialisation in Digestive System Medicine, Princesa Hospital (Madrid).
  • Clinical consultation. Diagnostic and therapeutic endoscopy: Chromoendoscopy, Colon Cancer Screening, Placement of digestive prosthesis (oesophagus, colon), Digestive dilatations, PEG Placement, Endoluminal Vacuum Therapy (fistulas/leaks), Polypectomy/mucosectomy. Experience in Bariatric Endoscopy: Intragastric balloon.

Dr. Diana Fresneda Cuesta

DIGESTIVE SYSTEM MEDICINE

  • Graduate in Medicine and Surgery.
  • MIR specialisation in Digestive System Medicine, Jiménez Díaz Foundation. (Madrid)
  • Clinical consultation. Specialist in Endoscopic Capsule and in Diagnostic and Therapeutic Endoscopy: Chromoendoscopy, Colon Cancer Screening, Ligation of Oesophagus Varices, Placement of digestive prosthesis (oesophagus, colon), Digestive dilatations, PEG Placement, Endoluminal Vacuum Therapy (fistulas/leaks), Polypectomy/mucosectomy. Experience in bariatric endoscopy: intragastric balloon, POSE method and Endo-sleeve with POSE system, etc.

Dr. Teresa Valdés Lacasa

DIGESTIVE SYSTEM MEDICINE

  • Graduate in Medicine and Surgery
  • MIR specialisation in Digestive System Medicine, 12 de Octubre University Hospital (Madrid). Advanced Endoscopy Fellowship (ERCP and digestive prostheses) at Ninewells Hospital (United Kingdom). 2020-2021.
  • Clinical consultation and abdominal ultrasound.
  • Specialist in pancreatico-biliary conditions and therapeutic endoscopy: ERCP, placement of digestive prostheses (oesophagus, duodenum, colon, biliary), digestive dilatations, placement of PEGs, endoluminal vacuum therapy (fistulas/leaks), polypectomy/mucosectomy.

Dr. Andrés J. del Pozo García, MD. PhD.

DUAL SPECIALISATION IN DIGESTIVE SYSTEM MEDICINE / FAMILY AND COMMUNITY MEDICINE

  • Graduate in Medicine and Surgery.
  • Dual specialised training (MIR) at the Princesa University Hospital (Madrid).
  • Specialist in Digestive System Medicine and Specialised in Family and Community Medicine
  • PhD in Medicine from the Autonomous University of Madrid. Cum Laude. 2020.
  • Member of S.E.P.D, S.E.E.D., A.E.G, E.S.G.E, AESPANC, Board Member of GETTEMO; Consultant of Apollo Endosurgery in 2021.

Dr. José María Abadal Villayandre

SPECIALIST IN VASCULAR INTERVENTIONAL RADIOLOGY

  • Graduate in Medicine and Surgery from Navarra University.
  • MIR specialisation in Radiology, Radiodiagnosis at Gregorio Marañón University Hospital.
  • PhD in Radiodiagnosis from the Complutense University of Madrid. Cum Laude Doctoral Thesis.
  • Specialist in Vascular Interventional Radiology, accreditation from the Spanish Society of Interventional Radiology.
  • European Board Interventional Radiology (EBIR) Health Sciences) at Alfonso X el Sabio University. 2010-2014.
  • Medical Director of the “Centro de Radiología y Diagnóstico por Imagen”.
  • Scientific and research activity with numerous publications and research studies.
  • Director and professor of Interventional Vascular Radiology at the I-XI Endo-school. Teaching activity.
  • Member of SERAM (Spanish Society of Medical Radiology), CIRSE (Cardiovascular Interventional Radiology Society Europe), and Secretary of SERVEI (Spanish Society of Interventional Vascular Radiology).

Belén Pérez Peiro. Psychologist

SPECIALIST IN PSYCHO-ONCOLOGY

  • Graduate in Psychology
  • Clinical psychologist, Gregorio Marañón University General Hospital, Psycho-oncology, Gynaecological Psychology, Neuropsychology, Detoxification and Out-patient Hospital, inflammatory bowel disease and teenagers.
  • Clinical activity at the Niño Jesús Children’s University Hospital, Psychiatric and Eating Disorder Units.
  • Expert qualification in Psychosomatic Medicine and Health Psychology.
  • Expert qualification in Psychopathology and Psychiatry from the Spanish Society of Psychosomatic Medicine and Medical Psychology.
  • Specialist qualification in Psychotherapy and projective techniques, both of which are recognised by the Madrid Official Association of Psychologists.

Dr. Ana María Moreno

SPECIALIST IN INTERNAL MEDICINE AND NUTRITIONAL PREHABILITATION

  • Graduate in Medicine and Surgery. 1986– 1992.
  • Extraordinary Graduation Award. 1992.
  • MIR specialisation in Internal Medicine. Number 283.
  • Master’s Degree in Palliative Care from Valladolid University. 2011.
  • University Master’s Degree in Advanced Chronic Nursing and palliative care from Antonio de Nebrija University. 2017.
  • PhD Courses 1993.
  • Extensive professional career in many renowned hospitals.
  • Head of Internal Medicine Services at Viamed Santa Elena (Madrid). September 2021 – Present.
  • Teaching and research work.
  • Numerous publications and papers. Participation in courses and seminars.