HIPEC Surgery for Abdominal Cancers
Featured Expert
Updated September 18, 2026
Hyperthermic intraperitoneal chemotherapy (HIPEC) surgery is a two-step procedure that treats certain cancers in the abdomen. Cancerous tumors are surgically removed, and then heated chemotherapy drugs are applied directly inside the abdomen to eliminate the remaining cancerous cells.
Norman Nicolson, M.D., M.H.S., a Johns Hopkins surgical oncologist, explains what to expect during HIPEC surgery and the benefits of this procedure.
Key Points
- HIPEC combines surgery and heated chemotherapy to treat certain cancers in the abdomen.
- Surgeons remove visible tumors first, then deliver chemotherapy directly into the abdominal cavity.
- The heated chemotherapy targets remaining cancer cells that may be too small to see or remove with surgery.
- HIPEC may improve treatment outcomes for some patients with advanced abdominal cancers.
What is HIPEC surgery?
HIPEC surgery is a specialized treatment for cancers that have spread to the lining of the abdominal cavity (the peritoneum). During the procedure, surgeons remove as much visible cancer as possible and then circulate a heated, concentrated chemotherapy solution throughout the abdomen to target remaining cancer cells. Because the chemotherapy is delivered directly to the affected area, HIPEC can be more effective than traditional systemic chemotherapy for certain abdominal cancers. It is most commonly used to treat cancers of the appendix, colon, ovaries, and peritoneum, and may improve outcomes for some patients when combined with surgery.
What types of cancer does HIPEC surgery treat?
The most common cancers treated with HIPEC include:
- Adrenal cancer
- Appendix cancer
- Colon and rectal cancer
- Gastric (stomach) cancer
- Liver cancer
- Mesothelioma
- Ovarian cancer
- Pancreatic cancer
- Peritoneal cancer
How is HIPEC surgery performed?
HIPEC surgery involves two stages:
Cytoreductive Surgery
Cytoreductive surgery is the first stage of HIPEC treatment and is performed under general anesthesia. During the procedure, the surgeon makes an incision in the abdomen and carefully examines the abdominal cavity to identify visible tumors and areas of diseased tissue. The goal is to remove as much cancer as possible, which helps improve the effectiveness of the heated chemotherapy delivered during the HIPEC portion of the treatment.
HIPEC Procedure
The second stage is the HIPEC procedure. After your surgeon removes all visible tumors and diseased tissue from the abdomen, they will insert a catheter containing the chemotherapy drugs, which are pumped into your abdominal cavity. The catheters are connected to a perfusion machine, which heats the chemotherapy drugs and flows them through your abdomen for one to two hours. Your surgeon will drain the remaining chemotherapy from the abdomen and rinse the abdomen with a salt solution before the incision is closed.
The amount of time the procedure takes may vary depending on how much cancer has spread throughout the abdomen. Advanced stage cancer may take longer to treat with surgery.
Am I a candidate for HIPEC surgery?
This depends on where your cancer originated and the severity of disease or cancer spread. Your doctor will determine if you are healthy enough to undergo the procedure.
What are the benefits of HIPEC surgery?
HIPEC surgery inserts high doses of chemotherapy directly into the abdomen, where traditional methods of chemotherapy cannot effectively reach.
This innovative procedure can improve long-term outcomes and provide more treatment options for patients who have been diagnosed with inoperable or advanced stage cancer.
Medically reviewed by Norman Nicolson, M.D., M.H.S.
Cytoreductive Surgery and HIPEC
Learn more about the advanced techniques involved in cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) at Johns Hopkins.
Peritoneal Surface Malignancy Program
The Johns Hopkins Peritoneal Surface Malignancy Program provides treatment for cancers that have spread from abdominal organs to the peritoneal cavity.
