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Traditionally gastrointestinal

Traditionally gastrointestinal cancers that had spread to the lining of the abdominal cavity (ie the peritoneum) were considered with a nihilistic approach and were considered stage 4. Their treatment is similar to other metastatic solid donors that include intravenous chemotherapy. Treatment with IV chemotherapy for such patients has led to poor outcomes over the last decade, ranging from 6 to 9 months of average survival and improved survival of new multi-modi chemotherapeutic regimens from 12 to 15 months. We all know that the lining of the stomach has different physiology than other solid organs in the body that sell metastatic cancer. The main difference is in their blood supply. In solid organs where the blood supply is enriched and on the other hand can receive high concentrations of chemotherapeutic drugs, a plasma peritoneal barrier (Fig2) has been found in the stomach lining, which results in a low concentration of drugs at these sites across the barrier. Restricts the spread of drugs. Leading to bad results. To overcome this plasma and lining of the stomach, the concept of intra peritoneal chemotherapy came up, where chemotherapy solution is given directly inside the abdomen at the time of surgery or after surgery. Chemotherapy cells act on microscopic cancer cells present on the lining of the stomach and effectively kill plasma - the peritoneal barrier inhibits the absorption of the drug into the circulation, reducing the side effects of the drug compared to traditional intravenous chemotherapy. This gives us the benefit of using larger doses of chemotherapy inside the abdominal cavity with fewer chances of complications. Adding heat to the chemotherapy solution increases the killing power of the drug and increases the healing power. During this novel technique of heated intraperitoneal chemotherapy (HIPEC), we transmit chemotherapy at a temperature of 43 degrees for a period of 60 to 90 minutes. A recently published article in the New England Journal of Medicine showed the benefit of adding HIPEC to the standard treatment of stage 3 ovarian cancer at the time of cyto reactive surgery that increased overall survival by 12 months. Similarly several studies in peritoneal cancer of colo rectal origin have shown an improvement in all survival compared with standard intravenous chemotherapy with HIPEC. HIPEC has always been combined with cytoreactive surgery where all of the first pathologies of the abdomen are removed through open incisions or through a critical piercing technique in potential patients with low disease weight. Hot chemotherapy is operated at a temperature of 43 degrees in the stomach for a period of 60 to 90 minutes after the entire illness. The idea behind this approach is that all visible tumour is removed and any small microscopic residual disease which is not seen by the eyes is taken care by the circulating chemotherapy in the abdomen. Another form of Intra peritoneal chemotherapy is Piped aerosol form which is called as PIPEC and used for those patients who have unresectable peritoneal disease in the abdomen and the chemotherapy is given to either control the growth of the disease or reduce the volume of the disease.

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