HIPEC (Hyperthermic Intraperitoneal Chemotherapy): How It Works, Recovery, and Risks

Written and medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026 · How we review

Quick Answer: What is HIPEC?

Hyperthermic intraperitoneal chemotherapy (HIPEC) is a cancer treatment for tumors in the abdominal cavity in which surgeons first remove visible tumors, then circulate chemotherapy heated to about 41 °C (108 °F) inside the belly to kill remaining cancer cells. It mainly treats cancers that have spread to the peritoneum. HIPEC does not cure cancer but may help people live longer. [1]

What the research says

• HIPEC added to surgery extended survival in stage III ovarian cancer. In a phase 3 trial of 245 patients who first received chemotherapy, median overall survival was 45.7 months with surgery plus HIPEC versus 33.9 months with surgery alone, with similar rates of severe side effects (27% vs 25%). (van Driel et al., N Engl J Med, 2018) [2]

• The benefit in ovarian cancer depends on timing. A meta-analysis of 6 randomized trials (737 patients) found HIPEC with interval surgery after chemotherapy lowered the risk of death at 5 years by 23% (RR 0.77) in newly diagnosed cancer, but showed no survival gain in recurrent ovarian cancer. (Filis et al., ESMO Open, 2022) [3]

• Not every cancer gains from HIPEC. In a trial of 265 people with colorectal cancer spread to the peritoneum, median survival was 41.7 months with surgery plus oxaliplatin HIPEC versus 41.2 months with surgery alone, and serious complications at 60 days were more common with HIPEC (26% vs 15%). (Quénet et al., Lancet Oncol, 2021) [4]

Key takeaways

• HIPEC is the second step of a two-part operation: cytoreductive surgery (CRS) removes visible tumors, then heated chemotherapy washes the abdominal cavity. [1]

• It is mainly used for cancers that have spread to the peritoneum, such as ovarian, colorectal, appendix, and stomach cancer. [1]

• The whole operation takes about 5 to 10.5 hours; the heated chemotherapy itself lasts 30 minutes to 2 hours. [1]

• Full recovery usually takes 4 to 12 weeks, including several days to 2 weeks in the hospital. [1]

• HIPEC does not cure cancer, and cancer can come back in the abdomen after treatment. [1]

How does HIPEC treat cancer in the abdomen?

HIPEC treats cancer in the abdomen by placing heated chemotherapy drugs directly inside the peritoneal cavity, the space that holds the liver, stomach, intestines, and other organs. [1]

The peritoneum is the membrane that lines this cavity. It acts as a barrier that standard chemotherapy, which travels through the bloodstream, cannot easily cross. [1]

HIPEC bypasses that barrier. The drug touches the tumor surfaces directly, and the heat makes it even more toxic to cancer cells. [1]

Which cancers can HIPEC treat?

HIPEC treats cancers inside the abdominal cavity, most often cancers that have spread (metastasized) there from another organ. [1] When cancer spreads across the abdominal lining, it is called peritoneal carcinomatosis.

Doctors recommend HIPEC only when the expected benefits clearly outweigh the risks. If it is suggested for you, ask why you are a good candidate and how it fits your long-term care goals. [1]

How do you prepare for HIPEC?

Preparing for HIPEC means getting into the best possible physical and mental health before a long, intensive operation. [1] Your care team may ask you to:

• Quit smoking

• Stop drinking alcohol

• Use an incentive spirometer to strengthen your lungs

• Join a cancer support group or see a therapist who works with people living with cancer

What happens during the HIPEC procedure?

The HIPEC procedure happens in two parts under general anesthesia, so you are asleep and feel no pain throughout. [1]

Part 1 — Cytoreductive surgery (CRS): Surgeons remove the visible tumors and diseased tissue from the abdominal cavity. [1]

Part 2 — HIPEC: The surgical team then:

1. Inserts a catheter through an incision in the belly, connected to a machine that heats the chemotherapy to about 41 °C (108 °F).

2. Delivers the drug, as the machine pumps the heated chemotherapy into the belly.

3. Spreads it evenly by gently tilting your body side to side, much like rinsing a bowl.

4. Drains and rinses the cavity, removing the chemotherapy and washing with saline.

5. Closes the incisions made during surgery and HIPEC. [1]

How long does HIPEC surgery take?

HIPEC surgery, including cytoreduction, takes about 5 to 10.5 hours, depending mostly on how much cancer is in the belly. [1] The heated chemotherapy portion lasts from 30 minutes to 2 hours of that total. [1]

Which chemotherapy drugs are used in HIPEC?

The chemotherapy drugs most often used in HIPEC are carboplatin, cisplatin, doxorubicin, fluorouracil, mitomycin, oxaliplatin, and paclitaxel. [1] Each works slightly differently, and your oncologist chooses the drug or combination based on your cancer. Learn more in our guide to chemotherapy drugs and how they work.

What are the benefits and risks of HIPEC?

The main benefit of HIPEC is delivering high-dose, cancer-killing drugs to an area that chemotherapy given through a vein cannot normally reach. [1]

Your surgeon will explain the specific risks for your cancer and the drugs planned. [1]

What is recovery like after HIPEC?

Recovery after HIPEC usually takes 4 to 12 weeks in total, including several days to 2 weeks in the hospital. [1]

• Intensive care: You may spend a few days in the ICU, sometimes on a ventilator to help with breathing. [1]

• Hospital ward: A feeding tube may be needed for days or weeks, because large chemotherapy doses can slow bowel function. [1]

• Home: Your care team explains how to prepare for recovery at home. [1]

What side effects are common after HIPEC?

Common side effects after HIPEC include bloating, constipation, diarrhea, fatigue, nausea and vomiting, pain at the incision, and swelling. [1] The swelling happens because the saline rinse can make the body hold extra fluid right after surgery. [1]

When should you call your doctor after HIPEC?

You should call your doctor right away after HIPEC if you notice any of these signs of infection or poor healing: [1]

• Fever above 38.3 °C (101 °F)

• Nausea and vomiting that do not improve

• Severe swelling, warmth, or drainage around the incision

• Pain that keeps getting worse

Can cancer come back after HIPEC?

Cancer can come back after HIPEC, because the treatment does not cure cancer. [1] Tumors may return in the belly, and new tumors can form if cancer elsewhere in the body spreads to the abdomen. [1]

For many people, though, HIPEC means longer survival with fewer symptoms. In advanced ovarian cancer, adding CRS and HIPEC after systemic chemotherapy extended life expectancy. [1][3] Your outlook depends on many factors, so ask your care team which ones apply to you.

Conclusion

HIPEC pairs cancer surgery with heated chemotherapy washed directly through the abdomen, reaching cancer cells that standard chemotherapy cannot. It is a long and demanding operation with a recovery of up to three months, and it is not a cure. In carefully selected people, especially those with advanced ovarian cancer, it can extend life.

If you or someone you love has been offered HIPEC, bring this guide to your next appointment and ask your team about your candidacy, the drug they plan to use, and what recovery will look like for you.

Keep learning: Read our guides to peritoneal carcinomatosis, ovarian cancer, appendix cancer, and chemotherapy.

FAQ

What does HIPEC stand for?

HIPEC stands for hyperthermic intraperitoneal chemotherapy. "Hyperthermic" means heated, and "intraperitoneal" means delivered inside the abdominal (peritoneal) cavity.

Is HIPEC a cure for cancer?

HIPEC is not a cure for cancer. It may help people live longer with fewer symptoms, but tumors can return in the abdomen after treatment.

How hot is the chemotherapy in HIPEC?

The chemotherapy in HIPEC is heated to about 41 °C (108 °F). The heat makes the drug even more toxic to cancer cells.

How long does HIPEC surgery take?

HIPEC surgery with cytoreduction takes about 5 to 10.5 hours. The heated chemotherapy itself lasts 30 minutes to 2 hours, and total time depends on how much cancer is in the belly.

How long is recovery after HIPEC?

Recovery after HIPEC usually takes 4 to 12 weeks. This includes several days to 2 weeks in the hospital, sometimes starting with a few days in intensive care.

Which cancers are treated with HIPEC?

HIPEC treats cancers that have spread to the abdominal cavity, such as ovarian, colorectal, appendix, stomach, liver, and adrenal cancer. It also treats cancers that start there, including primary peritoneal cancer, peritoneal mesothelioma, and pseudomyxoma peritonei.

What are the side effects of HIPEC?

Side effects of HIPEC include bloating, constipation, diarrhea, fatigue, nausea, vomiting, incision pain, and swelling. Surgical risks include bleeding and infection.

When should I seek urgent care after HIPEC?

Seek urgent care after HIPEC for a fever above 38.3 °C (101 °F), vomiting that does not improve, severe swelling, warmth or drainage at the incision, or worsening pain. These can be signs of infection or poor healing.

What is cytoreductive surgery?

Cytoreductive surgery is the first part of HIPEC, when surgeons remove all the visible tumors in the abdomen. The heated chemotherapy is then used to treat cancer cells that are too small to see.

Who is a good candidate for HIPEC?

HIPEC is usually considered for cancer that has spread to the lining of the abdomen but not far beyond it. You also need to be healthy enough for a long, major operation, so ask your team why it fits your care goals.

Related Reading

Hyperthermia Therapy for Cancer: Types and How It Works explains hyperthermia therapy for cancer.

References

1. Cleveland Clinic. Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Cleveland Clinic. Last updated April 4, 2025. https://my.clevelandclinic.org/health/treatments/21569-hyperthermic-intraperitoneal-chemotherapy-hipec

2. van Driel WJ, Koole SN, Sikorska K, et al. Hyperthermic Intraperitoneal Chemotherapy in Ovarian Cancer. N Engl J Med. 2018;378(3):230-240. PMID 29342393. https://doi.org/10.1056/NEJMoa1708618

3. Filis P, Mauri D, Markozannes G, et al. Hyperthermic intraperitoneal chemotherapy (HIPEC) for the management of primary advanced and recurrent ovarian cancer: a systematic review and meta-analysis of randomized trials. ESMO Open. 2022;7(5):100586. PMID 36116421. https://doi.org/10.1016/j.esmoop.2022.100586

4. Quénet F, Elias D, Roca L, et al. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy versus cytoreductive surgery alone for colorectal peritoneal metastases (PRODIGE 7): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol. 2021;22(2):256-266. PMID 33476595. https://doi.org/10.1016/S1470-2045(20)30599-4

Further reading (external)

• Ramos Santillan V, Menon G, Di Napoli R. Cytoreduction (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). StatPearls. Last updated May 7, 2026. https://www.ncbi.nlm.nih.gov/books/NBK570563/

• Langellotti L, Fiorillo C, D'Annibale G, et al. Efficacy of Cytoreductive Surgery (CRS) + HIPEC in Gastric Cancer with Peritoneal Metastasis: Systematic Review and Meta-Analysis. Cancers (Basel). 2024;16(10):1929. PMID 38792007. https://doi.org/10.3390/cancers16101929

• Hu J, Wang Z, Wang X, et al. Side-effects of hyperthermic intraperitoneal chemotherapy in patients with gastrointestinal cancers. PeerJ. 2023;11:e15277. PMID 37138820. https://doi.org/10.7717/peerj.15277

Disclaimer

This article is for general education only and does not replace advice from your doctor or cancer care team. Decisions about HIPEC depend on your cancer type, stage, overall health, and goals. If you have urgent symptoms after surgery, contact your care team or local emergency services immediately.