CRS-HIPEC stands for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. It’s pronounced “high-peck.” This treatment is for people with cancer that has spread to the lining of the abdomen. It combines two parts in one operation. The first is surgery to remove all visible areas of cancer. The second is warm chemotherapy put into the abdomen right after surgery to treat any cancer cells that remain.
CRS-HIPEC may be an important option even for people who were told elsewhere that there was no effective way to treat their disease.
Colon Cancer Care Tailored to You
You and your family are our top priority. At Fred Hutch Cancer Center, we offer comprehensive and compassionate care — personalized to you. You'll have access to the latest treatment options, clinical trials and supportive care services.
How CRS-HIPEC Works
In CRS, the surgeon removes the parts of the abdominal lining (peritoneum) where they can see cancer. Often, they also need to remove parts of organs that also have cancer. Usually, this is open surgery, meaning it is done through one large incision (cut). Sometimes, we do minimally invasive laparoscopic surgery or robot-assisted surgery.
After taking out all the cancer they can see, your surgeon puts warm (hyperthermic), liquid chemotherapy medicine into your abdomen. The medicine is warmed because this helps it destroy any microscopic cancer cells that were left behind. It stays inside you for about one to two hours. This helps make sure that the medicine coats your abdomen well. Then the surgeon drains the medicine, washes out your abdomen with a sterile solution and closes the incision.
Why Choose Fred Hutch for CRS-HIPEC
At Fred Hutch Cancer Center and UW Medicine, we have an experienced team that provides CRS-HIPEC. They have special training in this highly specialized procedure. You will have a surgical oncologist and a surgical oncology advanced practice provider with a special focus on caring for people before, during and after CRS-HIPEC.
Many of our patients receive all their cancer care through Fred Hutch and UW Medicine locations. We also offer CRS-HIPEC to people from across the state, the region and beyond who are getting other parts of their care from their local clinicians. Our team gives second opinions as well.
The physicians and researchers at Fred Hutch are always asking how we can make treatment better and reduce side effects. This is why we do clinical trials. Surgical oncologist Harveshp D. Mogal, MD, MS, specializes in CRS-HIPEC. He has studied outcomes for people with advanced peritoneal cancers who need this treatment. His research has looked at topics like how we can better select candidates for this procedure, how we can reduce health concerns that might happen because of surgery and how we can improve patient well-being.
This treatment is for people with peritoneal carcinomatosis, or cancer that has spread to the peritoneum from the colon or another organ in the abdomen. This is also called peritoneal cancer. (CRS-HIPEC is also used for stomach cancer, ovarian cancer, mesothelioma of the abdomen and some rare sarcomas that can spread to the peritoneum.)
“Developing a treatment plan [for peritoneal cancer] involves highly complex clinical decision-making,” said medical oncologist Stacey Cohen, MD, who co-leads the multidisciplinary CRS-HIPEC clinic at Fred Hutch with Dr. Mogal.
To decide if you might benefit from CRS-HIPEC, your Fred Hutch and UW Medicine team will look carefully at many factors. These include your tumor type, your previous response to chemotherapy and if your tumor is likely to respond well to HIPEC. The right candidate depends on their tumor biology, said Dr. Mogal.
“When we evaluate patients for this procedure, we also consider their age, medical conditions and overall health,” said Dr. Mogal. “Our goal is to select patients who can tolerate surgery and bounce back. The aim is to balance long-term survival with a good quality of life.”
Your care team will explain everything you need to know to prepare. At Fred Hutch, all patients are evaluated by a multidisciplinary team. The team includes a registered dietitian, physical therapist, surgical nurse and in some cases a stoma nurse. Our team approach helps ensure you are getting ready for the surgery and post-operative recovery.
On the day of surgery, you will meet with the anesthesia team to discuss a plan for how best to control your pain. Surgery can last eight to 12 hours. After surgery, you may be admitted to the intensive care unit or the surgical floor for recovery.
Right after surgery, you can expect pain in the incision. We’ll control this with medicine given through a line that goes into vein (intravenous line) or a small tube that sends the medicine to the space around your spine (epidural catheter). The acute pain management team will help with this. Once you are eating by mouth again, you will switch to oral pain medicine. Most patients have some mild discomfort that slowly gets better over weeks. While your pain is improving, you may take some pain medicine as needed.
This is a long, complex operation that can last up to 12 hours. Your care team will make a surgery plan based on everything they know about your cancer, where it is and which tissues likely need to be removed. They will explain beforehand how long they expect surgery to take in your case.
A surgical oncologist with special training in CRS-HIPEC performs this procedure. At Fred Hutch and UW Medicine, you have an experienced team working alongside your surgeon. They include an anesthesiologist, advanced practice provider, nurse, registered dietitian, physical therapist, social worker and others.
The pathology report from your surgery typically takes one to two weeks to come back. After this, you will be able to sit down with your team to discuss prognosis.
Each person is different. For example, some people need more tissue removed than others. Some are in stronger health at the time of surgery than others. So, recovery times differ. Your care team from Fred Hutch and UW Medicine will talk with you about what you can expect your recovery to be like.