HIPEC and PIPAC Treatment in Ahmedabad — Peritoneal Cancer Management at EPIC Multispecialty Hospital
HIPEC — Hyperthermic Intraperitoneal Chemotherapy — is a specialised surgical oncology procedure that combines cytoreductive surgery (CRS) with direct instillation of heated chemotherapy into the peritoneal cavity at the end of the operation. It is one of the most intensive cancer treatments available — a 6 to 12-hour surgery preceded by months of systemic chemotherapy, followed by 7 to 14-day hospital recovery and further systemic treatment. For appropriately selected patients with peritoneal surface malignancies — colorectal cancer with peritoneal metastases, peritoneal mesothelioma, pseudomyxoma peritonei, and selected ovarian cancer peritoneal disease — CRS-HIPEC offers the possibility of cure or long-term disease control that systemic chemotherapy alone cannot achieve.
PIPAC — Pressurised IntraPeritoneal Aerosol Chemotherapy — is a newer laparoscopic technique that delivers nebulised chemotherapy in aerosol form under pressure into the peritoneal cavity, achieving significantly higher drug concentration at the peritoneal surface than intravenous chemotherapy. PIPAC is used for patients with unresectable peritoneal malignancy — those who are not candidates for CRS-HIPEC — as a palliative or disease-modifying treatment that can convert some patients to resectability over repeated cycles.
At EPIC Multispecialty Hospital, Ahmedabad, both CRS-HIPEC and PIPAC are available — making our centre one of the limited number of hospitals in Gujarat and western India capable of providing this specialised peritoneal surface malignancy service. Patients from across Gujarat — from Vadodara, Surat, Rajkot, Gandhinagar, Anand, and Bharuch — and from Rajasthan and Madhya Pradesh seek HIPEC and PIPAC treatment here.
HIPEC and PIPAC at EPIC Multispecialty Hospital, Ahmedabad — Procedures, Indications, and Evidence
- What is cytoreductive surgery (CRS): CRS is the surgical component of CRS-HIPEC — systematically removing all macroscopic peritoneal disease through peritonectomy (stripping peritoneum from the abdominal and pelvic surfaces) and resection of involved organs. The Peritoneal Cancer Index (PCI) — scoring the extent of peritoneal disease across 13 abdominal regions — is calculated at diagnostic laparoscopy and intraoperatively. PCI above 20 for colorectal peritoneal metastases and above 20 to 25 for other malignancies is generally associated with poor outcomes from CRS-HIPEC. Completeness of cytoreduction (CC) score after CRS — CC-0 (no visible residual) — is the primary determinant of CRS-HIPEC benefit.
- HIPEC — the hyperthermic chemotherapy component: After CRS achieves complete or near-complete cytoreduction, the abdomen is perfused with heated chemotherapy solution (42 to 43°C) for 30 to 90 minutes. Heat enhances chemotherapy drug penetration into peritoneal tissue (thermal sensitisation) and increases drug cytotoxicity. Drug selection depends on the primary tumour: oxaliplatin or mitomycin-C for colorectal peritoneal metastases; cisplatin for ovarian cancer and mesothelioma; mitomycin-C for pseudomyxoma peritonei. The combination of complete CRS and HIPEC eliminates both macroscopic and microscopic peritoneal disease — a synergy that neither surgery alone nor systemic chemotherapy alone achieves.
- Indications for CRS-HIPEC: Colorectal cancer with peritoneal metastases confined to the peritoneum (PCI below 20, no extra-peritoneal disease): PRODIGE-7 trial for oxaliplatin HIPEC generated controversy but CRS without HIPEC still produces better survival than systemic chemotherapy alone, and HIPEC with mitomycin remains used at experienced centres. Pseudomyxoma peritonei (appendiceal mucinous neoplasms spreading to the peritoneum): CRS-HIPEC is the definitive curative treatment. Peritoneal mesothelioma: CRS-HIPEC achieves long-term survival in selected patients. Ovarian cancer peritoneal disease: the OVHIPEC-1 trial demonstrates improved survival for CRS-HIPEC over interval debulking alone for stage III ovarian cancer.
- PIPAC — pressurised aerosol chemotherapy: PIPAC delivers chemotherapy via a laparoscopic nebuliser under positive pressure (capnoperitoneum at 12mmHg), creating a high-pressure aerosol that penetrates peritoneal tissue to 3 to 5mm depth — significantly higher local drug concentration than intravenous delivery, at much lower systemic dose. PIPAC is performed as a repeated laparoscopic procedure every 6 to 8 weeks. Indications include unresectable peritoneal carcinomatosis from colorectal cancer, gastric cancer, ovarian cancer, and other primaries — providing disease control, symptom palliation (particularly ascites reduction), and in some patients converting unresectable to resectable disease enabling subsequent CRS-HIPEC. At EPIC Multispecialty Hospital, Ahmedabad, PIPAC is available for appropriately selected patients with unresectable peritoneal malignancy.
- Patient selection — who benefits from CRS-HIPEC: CRS-HIPEC is not appropriate for all patients with peritoneal malignancy. Selection criteria include: resectable disease with PCI below 20 (colorectal) or below 25 (ovarian, mesothelioma); no extra-peritoneal haematogenous metastases; adequate performance status (ECOG 0 to 1); adequate organ function (cardiac, pulmonary, renal, hepatic); and a patient who has been fully counselled about a major operation with 15 to 30 percent serious complication rate and 1 to 3 percent treatment-related mortality. Patient selection is made jointly by the surgical oncologist, medical oncologist, and the patient at EPIC Multispecialty Hospital, Ahmedabad, after rigorous pre-operative staging.
- Post-HIPEC recovery and systemic therapy: The CRS-HIPEC post-operative course typically involves 2 to 3 days in ICU and 7 to 14 days total hospital stay. Complications including anastomotic leak, intra-abdominal abscess, ileus, and haematological toxicity from intraperitoneal chemotherapy require experienced post-operative management. Adjuvant systemic chemotherapy is typically commenced 4 to 6 weeks after CRS-HIPEC for colorectal and ovarian primaries. Long-term follow-up with CT and tumour markers every 3 to 6 months monitors for disease recurrence.
HIPEC Treatment in Ahmedabad — Who Should Be Referred and Why Programme Expertise Matters
CRS-HIPEC is one of the few areas of cancer surgery where the outcome difference between experienced high-volume centres and inexperienced low-volume programmes is dramatic enough to be a genuine ethical concern. Treatment-related mortality for CRS-HIPEC at expert centres is 1 to 3 percent; at centres with limited experience, it approaches 5 to 10 percent. Serious complication rates at expert centres are 15 to 25 percent; at inexperienced centres, they exceed 40 percent. These differences reflect not just surgical skill but the entire perioperative ecosystem — the anaesthetic management of a 6 to 10-hour procedure with significant fluid shifts, the ICU team’s experience with HIPEC-specific post-operative complications, the oncological team’s experience with intraperitoneal chemotherapy dosing and toxicity management, and the institutional culture that delivers consistent protocols.
For patients in Ahmedabad and across Gujarat who have been diagnosed with peritoneal carcinomatosis — from colorectal cancer, ovarian cancer, or appendiceal mucinous neoplasm — the most important first step is staging that accurately characterises the PCI. CT scanning, while valuable for identifying gross peritoneal disease, underestimates PCI by 30 to 40 percent compared to diagnostic laparoscopy. At EPIC Multispecialty Hospital, Ahmedabad, diagnostic laparoscopy for PCI assessment is performed before CRS-HIPEC planning — because committing a patient to a major operation without knowing the true intraperitoneal disease burden risks a non-therapeutic laparotomy.
The second most important question for patients with peritoneal malignancy in Ahmedabad is whether they have been seen by an oncologist who is familiar with peritoneal surface malignancy as a distinct oncological entity, not simply as ‘stage 4 cancer’. Peritoneal carcinomatosis from colorectal cancer, when managed exclusively as metastatic disease with systemic chemotherapy, has a median survival of 12 to 18 months. The same disease managed with CRS-HIPEC at experienced centres in appropriately selected patients achieves median survival of 30 to 40 months with 5-year survival rates of 20 to 30 percent. This is not a marginal difference — it is a different clinical trajectory — and it requires a specialist who recognises peritoneal disease as potentially treatable with curative intent.
Know Your Signs
Unexplained weight loss
Loss of appetite
Easy bruising or unusual bleeding
Weakened immune system
Persistent fatigue or weakness
Persistent or unexplained pain
Pale skin or breathlessness
Bone or joint pain
Emergency Services
Our dedicated emergency team is available 24/7 to provide immediate medical care and support in critical situations.
Get In Touch
BOOK AN APPOINTMENT
Find Best Oncology, Haematology & Bone Marrow Transplant Hospital in Ahmedabad
Dedicated Day-Care Chemotherapy Unit
Multidisciplinary team approach
Complete cancer care under one roof - screening, diagnosis, treatment, transplant & follow-up
Highly experienced team of Oncologists, Hemato-Oncologists, and Blood Cancer & Transplant Experts
State-of-the-art infrastructure with Class 1000 Separate AHU (Air Handling Unit)
Strong focus on patient safety, strict infection control, and quality care
24×7 critical care support
Dedicated HEPA-filtered isolation rooms for BMT & immunocompromised patients
Our Team of Expert Doctors
DR. SANDIP SHAH
M.D., FELLOWSHIP IN MEDICAL ONCOLOGY
DR. SANKET SHAH
M.D., D.M., P.D.F.
Talks By Our Oncology, Haematology & Bone Marrow Transplant Expert Doctors
World Sickle Cell Awareness 23 by Dr. Ankit Raiyani, Haematologist & BoneMarrow Transplant Physician
Healthy life tips by Dr. Dhiren Parikh – EPIC Hospital Ahmedabad
Acute Erythroid Leukemia – Dr. Sandip Shah
Talks By Our Oncology, Haematology & Bone Marrow Transplant Expert Doctors
Acute Erythroid Leukemia – Dr. Sandip Shah
World Sickle Cell Awareness 23 by Dr. Ankit Raiyani, Haematologist & BoneMarrow Transplant Physician
Healthy life tips by Dr. Dhiren Parikh – EPIC Hospital Ahmedabad
Blogs By Our Oncology, Haematology & Bone Marrow Transplant Expert
Frequently Asked Questions — HIPEC PIPAC Treatment in Ahmedabad
What is HIPEC and who is it for?
HIPEC (Hyperthermic Intraperitoneal Chemotherapy) combines complete cytoreductive surgery with heated chemotherapy perfusion of the peritoneal cavity at the end of surgery. It is used for colorectal cancer with peritoneal metastases (PCI below 20), pseudomyxoma peritonei, peritoneal mesothelioma, and selected ovarian cancer cases. Complete cytoreduction (CC-0) is the prerequisite for HIPEC benefit.
What is PIPAC and how is it different from HIPEC?
PIPAC (Pressurised IntraPeritoneal Aerosol Chemotherapy) delivers nebulised chemotherapy via laparoscope under pressure — for patients with unresectable peritoneal malignancy who are not candidates for CRS-HIPEC. It is a repeated laparoscopic day procedure (every 6 to 8 weeks) providing high local drug concentration at low systemic dose. HIPEC is a one-time intensive surgical procedure; PIPAC is a repeated palliative/disease-modifying treatment.
Is HIPEC available in Ahmedabad at EPIC Hospital?
Yes. EPIC Multispecialty Hospital, Ahmedabad, provides cytoreductive surgery with HIPEC for appropriate patients with peritoneal surface malignancy, and PIPAC for patients with unresectable peritoneal disease. Our peritoneal surface malignancy programme is one of the limited services of this type available in Gujarat and western India.
What is the Peritoneal Cancer Index (PCI) and why does it matter for HIPEC?
PCI scores the extent of peritoneal disease across 13 abdominal regions (0 to 39 total). Higher PCI indicates more extensive peritoneal disease. PCI below 20 for colorectal peritoneal metastases is the threshold below which CRS-HIPEC offers meaningful survival benefit. PCI above 20 to 25 is generally associated with incomplete cytoreduction — and HIPEC without complete cytoreduction offers minimal benefit. Diagnostic laparoscopy at EPIC Multispecialty Hospital, Ahmedabad, determines the true PCI before CRS-HIPEC commitment.
How long is the recovery after CRS-HIPEC?
CRS-HIPEC requires 2 to 3 days of ICU care and 7 to 14 days total hospital stay at EPIC Multispecialty Hospital, Ahmedabad. The operation itself takes 6 to 10 hours. Return to normal activity takes 4 to 6 weeks. Adjuvant chemotherapy typically commences 4 to 6 weeks post-HIPEC.
What is pseudomyxoma peritonei and is it treatable with HIPEC?
Pseudomyxoma peritonei (PMP) is a rare condition arising from mucinous appendiceal neoplasms spreading mucin-producing cells to the peritoneum. CRS-HIPEC is the definitive curative treatment for PMP — removing all mucinous deposits from the peritoneal surfaces combined with HIPEC to sterilise the peritoneum. Five-year survival after CRS-HIPEC for low-grade PMP exceeds 80 percent at experienced centres.
Are patients from outside Ahmedabad accepted for HIPEC at EPIC Hospital?
Yes. EPIC Multispecialty Hospital, Ahmedabad, accepts HIPEC referrals from across Gujarat — Vadodara, Surat, Rajkot, Gandhinagar, Anand, Bharuch — and from Rajasthan, Madhya Pradesh, and Maharashtra. Patients undergo pre-operative staging including diagnostic laparoscopy, staging CT, and multi-disciplinary tumour board review before CRS-HIPEC is planned.
What is the cost of HIPEC treatment in Ahmedabad at EPIC Hospital?
CRS-HIPEC is a major surgical procedure with significant associated costs — 6 to 10-hour operating time, ICU stay, intraperitoneal chemotherapy drugs, and 7 to 14-day hospital admission. PIPAC is less expensive as a laparoscopic day procedure. Transparent pricing is available from our patient services team. Insurance coverage for CRS-HIPEC varies by policy. Contact our team for current pricing and insurance guidance.
HIPEC PIPAC Treatment in Ahmedabad — EPIC Multispecialty Hospital
HIPEC and PIPAC treatment at EPIC Multispecialty Hospital, Ahmedabad, offers patients with peritoneal surface malignancy access to a specialised oncological programme — cytoreductive surgery with hyperthermic chemotherapy for resectable peritoneal disease, and PIPAC for unresectable disease — that is available at only a limited number of centres in Gujarat and western India.
Book a HIPEC/PIPAC consultation online, call EPIC Multispecialty Hospital Ahmedabad today, WhatsApp your CT staging and oncology notes for initial peritoneal surface malignancy programme review, or visit us directly — and find out whether CRS-HIPEC or PIPAC is a treatment option for your peritoneal cancer.