Procedures like Hyperthermic Intraperitoneal Chemoperfusion (HIPEC) and minimally invasive robotic surgery offer new hope for patients in the advanced stage of ovarian cancer.
Until recently, treatment options for patients with advanced-stage ovarian cancer have only included surgery and conventional chemotherapy.
However, with HIPEC and robotic surgery, surgeons can potentially improve their odds and reduce the morbidity associated with traditional open procedures.
Joongho Shin, MD, is here to explain the Robotics and HIPEC Programs at Palmdale Regional Medical Center.
Selected Podcast
Robotics and HIPEC Programs for Cancer
Featured Speaker:
Learn more about Joongho Shin, MD
Joongho Shin, MD
Joongho Shin, MD is board certified in Colon/Rectal Surgery. Joongho Shin, MD is a member of the medical staff at Palmdale Regional Medical Center and at Keck Medicine of USC.Learn more about Joongho Shin, MD
Transcription:
Melanie Cole (Host): Hyperthermic intraperitoneal chemotherapy is one of the most innovative treatments available and combining this treatment with the latest robotics technology may give you the edge you’re looking for. My guest today is Dr. Joongho Shin. He is a member of the medical staff at Palmdale Regional Medical Center as well as a member of the medical staff at Keck Medicine of USC. Welcome to the show, Dr. Shin. Tell us a little bit about HIPEC and who is it used for?
Dr. Joongho Shin (Guest): Thank you for having me, Melanie. The HIPEC is hypothermic intraperitoneal chemotherapy. It is used for the peritoneal metastasis of colon cancer and, to a lesser extent, ovarian cancer and endo-gastric cancer. I’m a colorectal surgeon, so I mainly use it for patients who have cancer spread from the appendiceal cancer and colon cancer to the peritoneum.
Melanie: How does this innovative treatment work and when would you decide a patient needs this?
Dr. Shin: Typically, the patient has already had a surgery for the colon cancer and a few years later, they found out that their cancer recurred within the peritoneum which is a cavity of the abdomen. They typically undergo a period of systemic chemotherapy and we carefully evaluate whether or not the patient will benefit from this procedure. The most important part of this procedure is the site reduction. All of the research and experience has shown that the most important indicators of a long-term success is whether or not complete site reduction right before the HIPEC can be achieved.
Melanie: How does it work? It’s absolutely fascinating. Tell us a little bit about how it works.
Dr. Shin: Once we achieve a complete site reduction – whether it is taking out an organ or pushing of the tumor within the peritoneum – we insert two catheters: inflow and outflow. There is a special circuit that heats up the chemotherapy agent to 43 degrees and it constantly circulates the abdominal cavity for 90 minutes. The heated part also makes the penetration of the chemotherapy agent deeper into the peritoneum and helps to achieve a better delivery of the chemotherapy.
Melanie: Tell us some of the advantages of HIPEC.
Dr. Shin: For the peritoneal disease of the colon or appendiceal cancer and systemic chemotherapy, the effectiveness is limited. That’s where the HIPEC comes in.
Melanie: Is this allowing for higher doses of chemotherapy? What does it do for the patient?
Dr. Shin: The chemotherapy agent that is used in the HIPEC is slightly different from the systemic chemotherapy. We typically use a mitomycin. I use 5 FU. These agents are directly in contact with the peritoneal surface and any residual tumors, so the delivery is better and also the heating part also makes the toxicity of the chemotherapy agent to be increased.
Melanie: How does it affect the rest of the body’s exposure to chemotherapy?
Dr. Shin: Less than what you think because it only penetrates about a less than 2 millimeter of the peritoneal surface. Systemic absorption is fairly low. However, this procedure is not without its risks. There is a risk to the lungs, kidneys and the bowel. The patient’s recovery can be prolonged. That’s why it is crucial to have a preoperative evaluation of whether or not the patient is a best candidate for the HIPEC. For every five patients, probably one or two patients will be the candidate for the HIPEC.
Melanie: You mention the site of reductive surgery. Explain how the robotic surgery and HIPEC work together.
Dr. Shin: Actually, the robotics is separate from the site of reduction and the HIPEC. Robotic surgery is the new technology that allows a precise dissection within a small, confined space such as the pelvic area. In colorectal surgery, it is best to be used in the rectal cancer surgery.
Melanie: What would be the benefits for the patient? What happens after this particular procedure?
Dr. Shin: The benefit of the robotic surgery is it is minimally invasive, so the length of the cutting on the abdominal wall muscle is minimized. So, the patient’s postoperative pain can be much smaller and the recovery could be faster. That’s one benefit. The other benefit is the robotic instruments and the visualization itself allows the surgeons to precisely dissect within the very narrow pelvis to achieve the best outer flesh outcome.
Melanie: What about for HIPEC? What are some of the benefits for the patient? What is their recovery like?
Dr. Shin: The recovery from the HIPEC procedure depends on the extent of the site of reduction and also the patient’s age and comorbidity. In general the patient can expect can expect to stay in the hospital up to one to two weeks. But, overall, if the patient is well evaluated and deemed to be a good candidate for the HIPEC, the procedure itself can be done safely.
Melanie: In just the last few minutes, Dr. Shin, what should people with colorectal cancer be thinking about when they’re seeking care?
Dr. Shin: The first thing is the multidisciplinary care, especially in the rectal cancer. Both rectal cancer and colon cancer are highly curable diseases, especially at the earliest stage. In rectal cancer, it is important that the patient see a medical oncologist, radiation oncologist and surgeon at the same time before any of the treatment is studied and come up with the best plan for the treatment.
Melanie: Why should they come to Palmdale Regional Center for their care?
Dr. Shin: Palmdale Medical Center has experts from Palmdale Regional Medical Center itself as well as USC Keck Medical Center and they can provide the multidisciplinary care for the complex colorectal cancer care so that the patient can achieve the best outcome.
Melanie: Thank you so much for being with us today, Dr. Shin. It’s absolutely fascinating. You’re listening to Palmdale Regional Radio with Palmdale Regional Medical Center. For more information please visit PalmdaleRegional.com. That’s PalmdaleRegional.com. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): Hyperthermic intraperitoneal chemotherapy is one of the most innovative treatments available and combining this treatment with the latest robotics technology may give you the edge you’re looking for. My guest today is Dr. Joongho Shin. He is a member of the medical staff at Palmdale Regional Medical Center as well as a member of the medical staff at Keck Medicine of USC. Welcome to the show, Dr. Shin. Tell us a little bit about HIPEC and who is it used for?
Dr. Joongho Shin (Guest): Thank you for having me, Melanie. The HIPEC is hypothermic intraperitoneal chemotherapy. It is used for the peritoneal metastasis of colon cancer and, to a lesser extent, ovarian cancer and endo-gastric cancer. I’m a colorectal surgeon, so I mainly use it for patients who have cancer spread from the appendiceal cancer and colon cancer to the peritoneum.
Melanie: How does this innovative treatment work and when would you decide a patient needs this?
Dr. Shin: Typically, the patient has already had a surgery for the colon cancer and a few years later, they found out that their cancer recurred within the peritoneum which is a cavity of the abdomen. They typically undergo a period of systemic chemotherapy and we carefully evaluate whether or not the patient will benefit from this procedure. The most important part of this procedure is the site reduction. All of the research and experience has shown that the most important indicators of a long-term success is whether or not complete site reduction right before the HIPEC can be achieved.
Melanie: How does it work? It’s absolutely fascinating. Tell us a little bit about how it works.
Dr. Shin: Once we achieve a complete site reduction – whether it is taking out an organ or pushing of the tumor within the peritoneum – we insert two catheters: inflow and outflow. There is a special circuit that heats up the chemotherapy agent to 43 degrees and it constantly circulates the abdominal cavity for 90 minutes. The heated part also makes the penetration of the chemotherapy agent deeper into the peritoneum and helps to achieve a better delivery of the chemotherapy.
Melanie: Tell us some of the advantages of HIPEC.
Dr. Shin: For the peritoneal disease of the colon or appendiceal cancer and systemic chemotherapy, the effectiveness is limited. That’s where the HIPEC comes in.
Melanie: Is this allowing for higher doses of chemotherapy? What does it do for the patient?
Dr. Shin: The chemotherapy agent that is used in the HIPEC is slightly different from the systemic chemotherapy. We typically use a mitomycin. I use 5 FU. These agents are directly in contact with the peritoneal surface and any residual tumors, so the delivery is better and also the heating part also makes the toxicity of the chemotherapy agent to be increased.
Melanie: How does it affect the rest of the body’s exposure to chemotherapy?
Dr. Shin: Less than what you think because it only penetrates about a less than 2 millimeter of the peritoneal surface. Systemic absorption is fairly low. However, this procedure is not without its risks. There is a risk to the lungs, kidneys and the bowel. The patient’s recovery can be prolonged. That’s why it is crucial to have a preoperative evaluation of whether or not the patient is a best candidate for the HIPEC. For every five patients, probably one or two patients will be the candidate for the HIPEC.
Melanie: You mention the site of reductive surgery. Explain how the robotic surgery and HIPEC work together.
Dr. Shin: Actually, the robotics is separate from the site of reduction and the HIPEC. Robotic surgery is the new technology that allows a precise dissection within a small, confined space such as the pelvic area. In colorectal surgery, it is best to be used in the rectal cancer surgery.
Melanie: What would be the benefits for the patient? What happens after this particular procedure?
Dr. Shin: The benefit of the robotic surgery is it is minimally invasive, so the length of the cutting on the abdominal wall muscle is minimized. So, the patient’s postoperative pain can be much smaller and the recovery could be faster. That’s one benefit. The other benefit is the robotic instruments and the visualization itself allows the surgeons to precisely dissect within the very narrow pelvis to achieve the best outer flesh outcome.
Melanie: What about for HIPEC? What are some of the benefits for the patient? What is their recovery like?
Dr. Shin: The recovery from the HIPEC procedure depends on the extent of the site of reduction and also the patient’s age and comorbidity. In general the patient can expect can expect to stay in the hospital up to one to two weeks. But, overall, if the patient is well evaluated and deemed to be a good candidate for the HIPEC, the procedure itself can be done safely.
Melanie: In just the last few minutes, Dr. Shin, what should people with colorectal cancer be thinking about when they’re seeking care?
Dr. Shin: The first thing is the multidisciplinary care, especially in the rectal cancer. Both rectal cancer and colon cancer are highly curable diseases, especially at the earliest stage. In rectal cancer, it is important that the patient see a medical oncologist, radiation oncologist and surgeon at the same time before any of the treatment is studied and come up with the best plan for the treatment.
Melanie: Why should they come to Palmdale Regional Center for their care?
Dr. Shin: Palmdale Medical Center has experts from Palmdale Regional Medical Center itself as well as USC Keck Medical Center and they can provide the multidisciplinary care for the complex colorectal cancer care so that the patient can achieve the best outcome.
Melanie: Thank you so much for being with us today, Dr. Shin. It’s absolutely fascinating. You’re listening to Palmdale Regional Radio with Palmdale Regional Medical Center. For more information please visit PalmdaleRegional.com. That’s PalmdaleRegional.com. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.