15 Frequently Asked Questions : HIPEC Cancer Surgery in India for Zambian Patients

Q1 · What Is HIPEC Cancer Surgery?

HIPEC is a specialized treatment combining:

1. Cytoreductive Surgery — CRS

The surgeon removes visible tumour deposits from the abdominal cavity. Depending on the disease, this may involve removing portions of affected organs, peritoneal surfaces or other tumour-bearing tissues.

2. Hyperthermic Intraperitoneal Chemotherapy — HIPEC

After tumour removal, heated chemotherapy is circulated directly inside the abdominal cavity for a controlled period.

The aim is to treat microscopic cancer cells that may remain after the visible tumour has been removed.

HIPEC is therefore usually not a standalone treatment. It is generally performed immediately after cytoreductive surgery in appropriately selected patients.

The entire operation can be lengthy. Max Healthcare states that CRS and HIPEC may take approximately 6–9 hours, depending on complexity.

Q2 · What Is the Cost of HIPEC Cancer Surgery in Zambia Compared with India?

For planning purposes, the following exchange rates are used:

• US$1 ≈ ZMW 19.5
• US$1 ≈ INR 96

Indicative Cost Comparison

Published Indian sources currently report broad HIPEC costs ranging from approximately INR 3–15 lakh, with the final price depending on the cancer type, disease extent, PCI score, organs involved, surgeon, hospital, chemotherapy drugs, ICU stay and postoperative complications. Yashoda Hospitals currently gives approximately INR 4.5–15 lakh, while Oncare reports approximately INR 4–15 lakh.

The figures above should therefore be treated as planning estimates rather than fixed quotations.

A final quotation should be requested after the surgical team has reviewed the patient's scans and pathology.

Q3 · Which Major Indian Cities Can Zambian Patients Consider for HIPEC Cancer Surgery?

HIPEC availability is more specialized than conventional cancer surgery. A patient should therefore confirm that the selected hospital has an experienced CRS-HIPEC team, rather than choosing a hospital solely because it provides general cancer surgery.

Current Indian sources identify HIPEC programmes across major cities including Delhi NCR, Mumbai, Bengaluru, Chennai and Hyderabad.

Q4 · Which Hospitals in India Can Zambian Patients Consider?

Important: Not every hospital listed above necessarily performs CRS + HIPEC for every cancer type. The patient's specific cancer, PCI score and surgical requirements should be reviewed by the hospital's HIPEC team before travel.

Q5 · Which Cancers Can Be Treated With HIPEC?

HIPEC is primarily considered for selected cancers involving the peritoneal cavity.

Appendix Cancer and Pseudomyxoma Peritonei

HIPEC is an established treatment approach for selected patients with appendiceal tumours and pseudomyxoma peritonei.

Colorectal Cancer

Selected colorectal cancers that have spread predominantly to the peritoneum may be considered for CRS + HIPEC after detailed assessment.

Ovarian Cancer

HIPEC may be considered in selected advanced ovarian or primary peritoneal cancers, particularly in specific treatment settings.

Gastric Cancer

Selected patients with gastric cancer and limited peritoneal dissemination may be evaluated for CRS + HIPEC at specialist centres.

Peritoneal Mesothelioma

Selected patients with peritoneal mesothelioma may undergo CRS + HIPEC when the disease can be adequately cytoreduced.

Other Peritoneal Malignancies

Selected cases of:

• Primary peritoneal cancer
• Peritoneal sarcomatosis
• Other abdominal malignancies

may be considered at specialist centres.

Current clinical guidelines and multidisciplinary recommendations identify appendiceal, colorectal, gastric, ovarian, primary peritoneal and peritoneal mesothelioma among the major disease groups evaluated for CRS + HIPEC.

Q6 · What Is the Difference Between CRS and HIPEC?

CRS and HIPEC are two connected parts of the treatment.

CRS — Cytoreductive Surgery

The surgeon removes visible tumour deposits from the abdominal cavity.

Depending on the location and extent of disease, surgery may involve:

• Peritoneal tumour removal
• Removal of tumour deposits
• Partial bowel resection
• Appendix removal
• Ovarian or reproductive-organ surgery
• Stomach surgery
• Gallbladder or other organ procedures
• Other multivisceral resections

The exact operation varies substantially between patients.

HIPEC

After visible tumour has been removed, heated chemotherapy is circulated inside the abdomen.

The aim is to treat microscopic residual disease within the peritoneal cavity.

Therefore, the term CRS + HIPEC is generally more accurate than describing HIPEC as an independent operation.

Q7 · Who May Be Suitable for CRS + HIPEC?

HIPEC is generally considered only after detailed assessment.

Important factors include:

• Cancer type
• Cancer stage
• Distribution of peritoneal disease
• PCI score
• General health
• Age
• Nutritional condition
• Previous chemotherapy
• Response to chemotherapy
• Presence of disease outside the peritoneal cavity
• Ability to achieve adequate cytoreduction
• Ability to tolerate major surgery

Peritoneal Cancer Index — PCI

The PCI is an important assessment of the extent of tumour spread within the abdomen.

The abdomen is divided into regions and tumour deposits are assessed to calculate a score.

A lower disease burden may make complete cytoreduction technically more achievable in selected cancers, although the acceptable PCI depends on the cancer type and clinical situation.

Current multidisciplinary guidance emphasizes factors such as PCI, tumour biology, patient condition and the possibility of complete cytoreduction when deciding whether CRS + HIPEC is appropriate.

Q8 · What Medical Reports Should a Zambian Patient Send Before Travelling to India?

The patient should provide as complete a medical record as possible.

Cancer Records

• Oncologist report
• Surgical oncology report
• Biopsy report
• Histopathology
• Immunohistochemistry
• Molecular/biomarker reports
• Previous pathology reviews

Imaging

• CT scan abdomen and pelvis
• PET-CT where appropriate
• MRI
• Ultrasound reports
• Actual scan images/files rather than only written reports

Previous Treatment

• Previous surgery reports
• Chemotherapy records
• Radiotherapy records
• Treatment-response scans
• Discharge summaries
• Medication list

General Health

• Complete blood count
• Kidney function
• Liver function
• Electrolytes
• ECG
• Cardiac evaluation where necessary
• Nutritional assessment where available

For a possible CRS + HIPEC procedure, the surgical team needs enough information to assess the extent and distribution of peritoneal disease and whether meaningful cytoreduction may be possible.

In some cases, diagnostic laparoscopy may be recommended to assess disease distribution and PCI more accurately before committing to major CRS + HIPEC.

Q9 · What Is the Typical CRS + HIPEC Treatment Process in India?

Step 1 – Medical Record Review

The surgical oncology team reviews:

• Pathology
• CT/PET-CT/MRI
• Previous treatment
• Cancer stage

Step 2 – Specialist Consultation

The patient is assessed by an experienced surgical oncologist/HIPEC team.

Step 3 – Peritoneal Disease Assessment

The team evaluates:

• Location of disease
• Number of tumour deposits
• Bowel involvement
• Organ involvement
• PCI
• Possibility of complete cytoreduction

Step 4 – Multidisciplinary Review

The case may involve:

• Surgical oncology
• Medical oncology
• Radiology
• Pathology
• Anaesthesia
• Critical care
• Nutrition
• Gastrointestinal surgery
• Gynaecologic oncology where applicable

Step 5 – Pre-operative Preparation

The patient may undergo:

• Blood tests
• Cardiac assessment
• Nutritional optimization
• Anaesthesia assessment
• Additional imaging
• Diagnostic laparoscopy when required

Step 6 – Cytoreductive Surgery

Visible tumour is removed.

The extent of surgery depends on the organs and tissues involved.

Step 7 – HIPEC

After cytoreduction, heated chemotherapy is circulated within the abdominal cavity under controlled conditions.

Step 8 – Postoperative Recovery

The patient is monitored in the ICU or high-dependency unit when required and then transferred to the ward.

Step 9 – Pathology and Final Treatment Plan

The surgical specimens are examined and the oncology team determines the need for additional systemic treatment or surveillance.

Q10 · Are There Alternatives to HIPEC Cancer Surgery?

Yes.

Depending on the cancer and patient's condition, alternatives may include:

• Systemic chemotherapy
• Targeted therapy
• Immunotherapy
• Conventional cancer surgery
• Cytoreductive surgery without HIPEC
• Radiation therapy in selected situations
• Palliative procedures
• Supportive and symptom-directed treatment
• Clinical trials where available

Not every patient with peritoneal metastasis is suitable for CRS + HIPEC.

For some cancers and disease patterns, systemic treatment may be recommended instead.

The choice should depend on tumour biology, disease distribution, response to treatment, patient's health and the expected benefit of major surgery.

Q11 · What Should Be Included in the HIPEC Cancer Surgery Quotation?

A Zambian patient should request a detailed written quotation covering:

Surgical Component

• Cytoreductive surgery
• Surgeon fees
• Operating-room charges
• Anaesthesia
• Surgical consumables
• HIPEC equipment
• HIPEC chemotherapy drug
• Histopathology
• Special pathology tests

Hospital Component

• ICU/HDU charges
• Room charges
• Nursing
• Medicines
• Blood products
• Laboratory investigations
• Imaging
• Doctor visits

Additional Procedures

Ask whether the quotation includes possible:

• Bowel resection
• Stoma creation
• Ovarian surgery
• Gastric surgery
• Appendix surgery
• Other organ resections
• Reconstruction
• Additional surgical procedures

Additional Cancer Treatment

Clarify whether the package includes or excludes:

• Pre-operative chemotherapy
• Post-operative chemotherapy
• Immunotherapy
• Targeted therapy
• Molecular testing
• Follow-up imaging

Published Indian cost estimates show that the major variables include disease extent, PCI, organs involved, chemotherapy drugs, ICU stay and postoperative complications.

Q12 · How Long Should a Zambian Patient Stay in India?

CRS + HIPEC is a major operation and usually requires a significantly longer stay than routine cancer surgery.

Published Indian planning sources commonly describe hospital stays of approximately 7–21 days, with longer stays possible in complex cases or when complications occur.

A Zambian patient should avoid booking a return flight immediately after the minimum estimated hospital stay. Additional recovery time should be kept available.

Q13 · What Is Recovery Like After CRS + HIPEC?

Recovery after CRS + HIPEC is considerably longer than after many routine cancer operations because CRS can involve extensive abdominal surgery.

Early Recovery May Include

• Abdominal pain
• Fatigue
• Reduced appetite
• Temporary bowel dysfunction
• Nausea
• Weight loss
• Weakness
• Fluid and electrolyte monitoring
• Wound care
• Nutritional support

Hospital Recovery

The patient may require:

• ICU/HDU monitoring
• Pain management
• Antibiotics where indicated
• Blood tests
• Fluid management
• Nutritional support
• Physiotherapy
• Breathing exercises
• Gradual mobilization

Nutrition

Adequate nutrition is particularly important after major abdominal surgery.

The patient may initially require:

• Liquid or soft diet
• Nutritional supplements
• Gradual return to normal food

Longer-Term Recovery

Recovery may take several weeks or longer depending on the extent of surgery.

The patient should gradually increase:

• Walking
• Daily activities
• Physical activity
• Dietary intake

Heavy lifting and strenuous exercise should be avoided until cleared by the surgical team.

CRS + HIPEC is an extensive treatment with potentially significant morbidity, which is why patient selection and treatment at an experienced centre are important.

Q14 · What Follow-up Care Is Required After Returning to Zambia?

Before leaving India, the patient should collect:

• Final diagnosis
• Operative report
• CRS details
• HIPEC chemotherapy drug used
• HIPEC treatment summary
• Histopathology
• Lymph-node pathology
• Molecular/biomarker results
• Discharge summary
• Medication list
• Latest blood tests
• Latest imaging
• Wound-care instructions
• Dietary instructions
• Follow-up schedule

Follow-up May Include

• Clinical examination
• Blood tests
• CT scans
• PET-CT when appropriate
• Tumour markers
• Colonoscopy for selected colorectal patients
• Cancer-specific surveillance
• Nutritional assessment
• Monitoring for recurrence

If additional chemotherapy is recommended, the Indian oncology team should provide:

• Drug names
• Dose
• Number of cycles
• Treatment interval
• Expected side effects
• Monitoring requirements

The Zambian oncology team should receive the complete Indian treatment summary so that follow-up treatment can continue without unnecessary interruption.

Q15 · Is India a Suitable Option for Zambian Patients Seeking HIPEC Cancer Surgery?

India can be considered by Zambian patients who have selected cancers involving the peritoneum and who may be candidates for CRS + HIPEC.

Indian cancer centres have experience with CRS + HIPEC for conditions including appendiceal cancer and pseudomyxoma peritonei, colorectal cancer, ovarian cancer, gastric cancer and peritoneal mesothelioma.

However, HIPEC should not be chosen simply because the cancer has spread to the abdomen.

The most important questions are:

• What is the exact cancer type?
• What is the stage?
• How extensive is the peritoneal disease?
• What is the estimated PCI?
• Has the patient responded to chemotherapy?
• Can the visible tumour be adequately removed?
• Is disease present outside the peritoneum?
• Can the patient safely undergo major surgery?
• What is the expected benefit compared with systemic therapy?
• What additional chemotherapy or treatment will be needed?

Current multidisciplinary guidance emphasizes careful patient selection and the possibility of achieving adequate cytoreduction.

For Zambian patients, it is therefore useful to obtain a specialist CRS + HIPEC opinion based on complete pathology and imaging before travelling to India.

The final treatment decision should be made by the treating multidisciplinary cancer team after reviewing the individual patient's condition.