Gynecologic HIPEC Surgery

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Send your CT and your chemotherapy record, and find out whether HIPEC applies to your case

A gynaecological oncologist reads the CT, the histology and the record of the chemotherapy you have had so far, then tells you whether your situation falls inside the setting where heated chemotherapy has been shown to work, whether removing everything visible looks achievable, and what the operation and the stay would involve. The review costs nothing and carries no obligation. Send the files on WhatsApp and a coordinator answers in your own language.

Chemotherapy given through a vein reaches the abdominal lining poorly, because a barrier of tissue and blood vessels stands between the bloodstream and the peritoneal surface, so the concentration arriving where ovarian cancer actually sits is a fraction of what circulates elsewhere. Putting the drug directly into the abdomen inverts that. Concentrations at the surface climb far above anything a vein could deliver, while very little crosses back into the blood, which is why the whole-body side effects stay modest. Warming the fluid adds two further effects, since heat damages cancer cells directly at temperatures healthy tissue tolerates, and it makes platinum drugs penetrate a few millimetres deeper into tissue than they otherwise would.

Three things follow from that limit and they run through the rest of this page. The operation matters more than the perfusion. The perfusion earns its place only where evidence says it helps. And selection is what separates a treatment from a sales pitch.

One situation, and it needs stating precisely because a single word out of place changes whether the evidence applies to you. Advanced ovarian cancer, treated with chemotherapy first, then operated on at the interval when the disease has shrunk enough for the surgeon to remove everything visible. Heated chemotherapy added at the end of that operation. That is the setting the trials studied.

The Dutch OVHIPEC trial, published in the New England Journal of Medicine in 2018, randomised 245 women having interval surgery after three cycles of chemotherapy for stage III ovarian cancer, and reported median recurrence-free survival of close to 11 months without HIPEC against just over 14 months with it, and median overall survival of 34 months against nearly 46 months. Grade 3 or 4 side effects ran at 25 per cent in the surgery group and 27 per cent with HIPEC added, a difference the trial could not distinguish from chance. A systematic review and meta-analysis published in ESMO Open in 2022 then pooled six randomised trials and 737 patients, and separated the settings properly. In primary ovarian cancer treated with chemotherapy first and interval surgery, adding HIPEC improved five-year overall survival with a relative risk of 0.77 across 393 patients, and improved disease-free survival with a hazard ratio of 0.60. The risk of severe adverse events was no different between the groups.

That is the case for HIPEC in gynaecological cancer. It is a good one.

The same meta-analysis that supports HIPEC in one setting found nothing in any of the others, and this is the section most clinic pages leave out.

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Recurrent disease, where hope meets the data

Recurrent disease deserves a further word, because it is where most enquiries come from and where hope pushes hardest against evidence. A 2025 review in Cancers examined the five randomised trials covering recurrent ovarian cancer and concluded that secondary surgery itself benefits carefully selected patients under recognised scoring systems, while current evidence shows no additional benefit from adding heated chemotherapy when the surgery is performed as an adjuvant procedure. Selection for the operation is the useful conversation there. Adding a perfusion to it is not.

Turning down a treatment a patient has flown in asking for is uncomfortable. Doing it anyway is the reason the recommendation means something when it is yes.

Protocols vary between centres in drug, dose, temperature and duration, and those differences matter, because the survival figures quoted on any page belong to the specific protocol tested in the trial that produced them, which is why the protocol used here is the OVHIPEC one exactly.

An open technique keeps the abdomen held apart under a suspended sheet so the surgeon's gloved hand can move the fluid across every surface and confirm nothing is being missed behind a loop of bowel, while the closed technique sews the skin temporarily and perfuses a sealed abdomen, which holds heat more evenly and exposes the theatre team to nothing at all. Trials have not shown one to be better than the other for survival, so the choice is made on the anatomy in front of the surgeon rather than on principle. Ask any centre you are comparing for their drug, dose, temperature and duration. A team that answers in one sentence is running a protocol. A team that answers vaguely is running something else.

Five conditions have to hold together, and they are worth checking against your own file before you travel. Stage III ovarian, tubal or primary peritoneal cancer. At least three cycles of platinum-based chemotherapy already given, with the disease stable or responding rather than progressing. Imaging that suggests the surgeon can remove everything visible or leave nothing above a centimetre. Kidney function good enough for a substantial dose of cisplatin, which is checked with blood tests rather than assumed, and general fitness for a long operation followed by a demanding recovery, which the anaesthetist assesses independently of the surgeon and can veto on its own. All five have to hold.

The test that decides it most often

Failing kidneys deserve particular attention if you have had several cycles of platinum already, because that is the commonest reason a woman who otherwise qualifies has the perfusion left out, and it is something your own doctor can measure before you book a flight.

Debulking comes first and takes most of the day, and only when the surgeon is satisfied that nothing visible remains does the perfusion begin, by which point you have already been asleep for several hours.

Inflow and outflow tubes are placed into the abdomen and connected to a machine that heats, circulates and monitors the fluid, with temperature probes sitting at several points so the whole cavity can be kept at target rather than just the part nearest the inflow. Warmed saline circulates first until the abdomen reaches temperature, the cisplatin is added, and the ninety minutes start counting from that point. Throughout, the anaesthetist works against the physiology the heat creates, since a warmed abdomen raises your core temperature, speeds the heart and shifts large volumes of fluid, so cooling blankets, intravenous fluids and close monitoring of urine output run in parallel. Protective fluids are given specifically to carry the cisplatin through the kidneys. At ninety minutes the perfusate is drained, the abdomen is washed out thoroughly with saline, the drains and any bowel joins are completed, and the wound is closed. You go to intensive care as a planned step.

Two hours in total. Add that to a day already given over to the debulking operation, counting the setting up, the ninety minutes themselves and the washout at the end.

Most of what happens after this operation belongs to the surgery, and the trials found no significant increase in severe complications from adding the perfusion. A few problems are specific to the drug and the heat, though, and they are the ones to recognise.

Everything else that happens in the days after belongs to the debulking operation itself, which is described in full on the ovarian cancer surgery page in this Health Guide.

Honestly, the perfusion changes less than people expect, since trials comparing the two groups found similar rates of severe complications and the women who have been through both describe the surgery itself as the hard part.

What it does add is a little more time. One to two extra nights on the ward, a slightly longer stay in intensive care in some cases, a bowel that takes an extra day or two to wake, and a first week in which the daily blood tests matter more than they otherwise would, while fluid balance is watched harder because of the kidneys, so expect the drip to stay in for longer than it would for someone who had the same surgery without a perfusion.

Nausea in the first days is the thing most women mention afterwards.

From week two, the paths converge

From the second week onward the two recoveries converge. Fatigue, a wound that pulls when the abdominal muscles work, an appetite rebuilding slowly, short walks several times a day beating one long one. The timetable for going back to ordinary life, and for restarting the remaining chemotherapy cycles, is the same as after debulking surgery without a perfusion.

Gynecologic HIPEC surgery means three to four weeks in Istanbul, with the perfusion accounting for one or two days of that and the operation for the rest.

Expect three to five days of assessment, imaging review, kidney function testing and anaesthetic clearance, then the operation with the perfusion, then eight to fourteen nights in hospital beginning in intensive care, then ten to fourteen days of recovery under review while the wound settles and blood tests normalise. The full pathology arrives inside that window, and the plan for your remaining chemotherapy cycles is written before you leave.

Most women arrive having already had three cycles at home and go back for the remaining three, an arrangement that works smoothly whenever the two teams are writing to each other, and setting up that correspondence is part of the plan rather than something you are left to organise yourself.

Fitness to fly

Clot risk governs the flight and it is high after this operation, so injected anticoagulation continues for four weeks after discharge and travels home with you. General guidance after major abdominal surgery puts the earliest reasonable flight at around two weeks, and the stay described above puts you comfortably beyond that. One addition specific to HIPEC is that kidney function and blood counts are rechecked before you are cleared, since flying with a dehydrating cabin and a kidney still recovering from cisplatin is a combination worth avoiding, and you are told to drink steadily throughout the flight for the same reason.

HIPEC replaces nothing. The three remaining cycles of intravenous carboplatin and paclitaxel go ahead as planned, typically restarting three to six weeks after surgery once the wound has healed and blood counts have recovered, and the perfusion is an addition to that schedule rather than a substitute for part of it.

BRCA and homologous recombination deficiency testing continue exactly as they would otherwise, because the results decide whether maintenance treatment with a PARP inhibitor follows the chemotherapy and that decision is unaffected by whether a perfusion was given, and both tests are run in the laboratory here, mattering for your family as much as they matter for you.

Chemotherapy and radiotherapy are both delivered at Biruni Hospital, on the same site as the operation, so completing the remaining cycles here keeps one team and one set of records. Returning home for them works equally well when the operating team writes to your oncologist with the operation note, the residual disease statement, the confirmation that HIPEC was given and with which protocol, and the recommended schedule.

Make sure that confirmation is in writing. An oncologist treating you afterwards needs to know the drug and dose that went into your abdomen.

Perfusion is the small part of the bill and the operation is the large one, which is the opposite of how it is usually marketed.

How far the surgery has to go moves the total furthest, since clearing a pelvis and clearing an abdomen that needs diaphragmatic stripping, splenectomy and a bowel resection differ by hours of theatre and by how many surgeons are scrubbed. Intensive care comes next, with one or two nights planned and each extra night adding directly, followed by the ward stay of eight to fourteen nights. The perfusion itself contributes theatre time, the disposable circuit and the cisplatin. Then the monitoring it requires, meaning daily blood tests through the first week. Your own condition moves the figure too, since kidney function, nutrition, diabetes and previous abdominal surgery each lengthen either the operation or the stay. A package quoted in this market covers the pre-operative work-up, the surgeon and anaesthetist, theatre, the planned nights including intensive care, routine pathology, the coordinator and interpreter, transfers, an agreed run of hotel nights and the reviews before departure. It stops short of flights and insurance, nights beyond the plan, prolonged intensive care, the treatment of a complication, and the intravenous chemotherapy cycles.

Five questions turn a headline number into a real one. Whether the perfusion is priced inside the operation or added separately. What happens to the figure if the surgeon opens the abdomen and decides the perfusion should not go ahead. How many intensive care nights are counted. Whether the extended upper abdominal surgery is inside the quotation. And whether the quote is revised once the final pathology arrives.

Every figure you can rely on starts with a gynaecological oncologist reading your CT and your chemotherapy record. That reading is free.

Travel with someone. A month away, most of it spent recovering from a major operation in the middle of a course of chemotherapy, is not a trip to make alone, and the ward rooms carry a second bed so the person who comes with you sleeps in the room every night of the admission. Intensive care runs separate visiting arrangements for the first night or two, and rooms for the periods either side of the hospital stay, along with every journey between airport, hotel and hospital, are booked by the international patients office before you arrive. Consultations, consent and the ward round run in English, Arabic, French, Russian, Serbian, Romanian or Spanish, with interpreting in other languages arranged on request. Whoever answers your first message stays with the case and walks out with you on discharge day. Female surgeons are requested through the department and provided wherever the rota permits. The kitchen prepares halal, vegetarian and diabetic meals, and there is a prayer room in the building. Once a date is agreed, the office issues an appointment confirmation and an invitation letter naming the hospital and the treating doctor, which is what most consulates ask for.

What to send before you travel

The CT of chest, abdomen and pelvis with the actual image files and not only the radiologist's report, since the surgeon reads the pictures rather than the letter. The histology report with the tumour type and stage. A full record of the chemotherapy you have had, meaning which drugs, how many cycles, the dates and the response on the last scan. CA-125 values with their dates, which together show whether the disease is responding. Recent bloods including kidney function, since that decides whether the perfusion is safe for you. And operation notes from any previous abdominal surgery.

Your oncologist needs to know four things, and the document pack you leave with sets all of them out in English.

Start with the operation note, naming every organ removed and stating exactly what residual disease remained. Written confirmation that HIPEC was given, with the drug, the dose, the temperature and the duration, since an oncologist who does not know what went into your abdomen cannot judge what to give next. The full histopathology, with BRCA and homologous recombination results or the date they are expected. And a discharge summary listing every medication with doses and stop dates, including the four weeks of anticoagulation and any magnesium supplements.

Kidney function should be rechecked two to four weeks after you land and again before the next chemotherapy cycle, which your own team can arrange with a single blood test that takes minutes.

Surveillance afterwards follows the ordinary ovarian cancer pattern of examination, CA-125 and symptoms every three months for the first two years and less frequently after that, with imaging arranged when something changes, and having had a perfusion alters none of that schedule.

Your coordinator stays on the same number once you are home, and the surgical team treats questions from former patients as an ordinary part of the week. Pass on whatever your oncologist writes so the operating team can follow what happens next, and get in touch directly about a wound problem, persistent vomiting, reduced urine output or increasing abdominal pain in the first weeks.

None of those improve with waiting.