Hyperthermic Intraperitoneal Chemotherapy (HIPEC) + Cytoreductive Surgery | University Hospital Rechts der Isar Munich

At TUM Hospital Rechts der Isar in Munich, doctors offer hyperthermic intraperitoneal chemotherapy (HIPEC) in combination with cytoreductive surgery (CRS) for selected patients with tumor involvement of the peritoneum. The procedure is performed at our Clinic and Policlinic for Surgery, within specialized structures, including a dedicated HIPEC team led by Prof. Dr. Ihsan Ekin Demir, with the surgical clinic directed by Prof. Dr. Helmut Friess. CRS + HIPEC is intended for situations in which the disease is confined to the abdominal cavity, and the extent of peritoneal spread still allows a meaningful surgical tumor reduction. Preoperative assessment focuses on staging and feasibility: cross-sectional imaging is used to estimate the distribution of disease, and in many cases, the definitive assessment of resectability is made by direct inspection of the abdomen, using standardized scoring such as the Peritoneal Cancer Index (PCI). In the multicenter GASTRIPEC-I setting, for example, eligibility required peritoneal staging (laparoscopy or exploration), PCI assessment, and a realistic possibility of achieving a major tumor mass reduction as part of cytoreductive surgery. During CRS, a surgeon removes all visible tumor deposits from the peritoneum as far as technically possible; depending on tumor location and extent, this may include partial or complete resection of involved organs. Because microscopic tumor cells can remain even after maximal surgical tumor reduction, HIPEC is performed immediately afterward as an intraoperative regional chemotherapy: a specially prepared chemotherapy solution is warmed and circulated throughout the abdominal cavity via a perfusion system for a defined period to treat residual microscopic disease. The intraperitoneal chemotherapy regimen is selected based on the tumor entity and the protocol. In German gastric cancer HIPEC protocols evaluated in large multicenter trials, intraperitoneal perfusion has used agents such as mitomycin C and cisplatin with protocol-defined dosing and perfusate volumes. CRS + HIPEC is a highly specialized, resource-intensive treatment concept performed only in selected centers and only for carefully selected patients; when the disease is limited enough for effective cytoreduction, combined surgery and regional heated chemotherapy can meaningfully improve outcomes in appropriate indications. In addition to clinical delivery, HIPEC-related intraperitoneal treatment strategies are represented in the department’s clinical research portfolio. One listed example is the ProPec study, which evaluates whether adding hyperthermic intraperitoneal chemoperfusion at the time of curative gastrectomy for gastric cancer or gastroesophageal junction adenocarcinoma can reduce the incidence of peritoneal metastases/peritoneal carcinomatosis.