Amanda Nasrallah, Fifth-year Medical Student at Al-Quds University, and Palestine National Delegate at IASSS (International Association of Student Surgical Societies), shared a Review Abstract on Use of HIPEC Surgery in Palestine:
“Use of HIPEC Surgery in Palestine: A Comprehensive Review
Review Abstract
Hyperthermic intraperitoneal chemotherapy (HIPEC) combined with cytoreductive surgery (CRS) is an important method for managing peritoneal surface tumors. This review looks at global evidence, local developments, and the growing role of HIPEC in Palestine. Although HIPEC is still limited, August Victoria Hospital (AVH) has started offering CRS/HIPEC, marking a significant step forward. Systemic challenges include issues with infrastructure, finances, politics, and workforce. Recommendations for future growth are included.
Introduction
Peritoneal surface tumors (PSMs) are a diverse group of cancers that come from the gastrointestinal or gynecologic tract. Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has become standard treatment for certain patients around the world. HIPEC allows direct exposure of any remaining microscopic disease to heated chemotherapy, which lowers systemic toxicity. This review examines the state of HIPEC in Palestine.
Methods
A focused literature review was done using peer-reviewed articles, institutional reports, regional oncology publications, and other non-traditional sources. Search terms included “HIPEC Palestine,” “cytoreductive surgery Palestine,” “Augusta Victoria Hospital oncology,” and “HIPEC MENA region.” Sources from PubMed, Springer, AVH institutional pages, and regional reports were analyzed.
Global Overview of CRS/HIPEC
CRS/HIPEC is commonly used in large cancer centers. Evidence shows improved overall survival for selected patients with pseudomyxoma peritonei, appendiceal tumors, colorectal carcinomatosis, peritoneal mesothelioma, and ovarian cancer. Outcomes depend significantly on tumor biology, Peritoneal Cancer Index (PCI), and the completeness of cytoreduction (CC score).
Indications and Patient Selection
Selecting the right patient is very important. Perfect candidates usually present with disease limited to the peritoneal cavity, an operable PCI, feasibility of complete cytoreduction, and good performance status. Contraindications include extensive extra-peritoneal disease or inability to achieve cytoreduction.
HIPEC Technique Overview
HIPEC takes place directly after CRS either through closed or open techniques. The peritoneal cavity is infused with chemotherapy agents (e.g., mitomycin-C, cisplatin, oxaliplatin) at 41–43°C. Heat increases the effectiveness of the drugs and helps them penetrate deeper. The procedure lasts 60–120 minutes.
HIPEC in Low- and Middle-Income Countries (LMICs)
LMIC adoption remains low due to high resource needs, lack of trained oncologic surgeons, limited ICU capacity, high equipment costs, and unstable funding. Training partnerships have helped establish programs in parts of the MENA region.
Current Status of HIPEC in Palestine
In the past, Palestine lacked facilities for CRS/HIPEC. Recently, Augusta Victoria Hospital (AVH) in East Jerusalem became the first to perform HIPEC-related surgeries. Case reports show successful treatment of pseudomyxoma peritonei and other cancers. Access remains limited, and many patients still require treatment abroad.
Barriers to Implementation
Major challenges include limited infrastructure, shortage of trained workforce, high costs, mobility restrictions for Gaza and parts of the West Bank, and absence of a national cancer registry for HIPEC outcomes.
Opportunities and Future Directions
Key opportunities include establishing AVH as the national HIPEC referral center, creating fellowships with regional centers, developing national guidelines, and establishing a peritoneal malignancy registry.
Conclusion
HIPEC offers a transformative approach to managing peritoneal surface malignancies. Although Palestine is early in its implementation journey, AVH’s introduction of CRS/HIPEC represents significant progress. Continued investment in training, infrastructure, and national data systems will help expand access and improve outcomes.
References (APA)
- Sugarbaker, P. H. (1995). Peritonectomy procedures. Annals of Surgery, 221(1), 29–42. Chua, T. C., Moran, B. J., Sugarbaker, P. H., Levine, E. A., Glehen, O., Gilly, F. N., … & Morris, D. L. (2012). Early- and long-term outcome data of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis. Journal of Clinical Oncology, 30(20), 2449–2456.
- van Driel, W. J., Koole, S. N., Sikorska, K., Schagen van Leeuwen, J. H., Schreuder, H. W. R., Hermans, R. H. M., … & Verwaal, V. J. (2018). Hyperthermic intraperitoneal chemotherapy in ovarian cancer. The New England Journal of Medicine, 378(3), 230–240.
- Esquivel, J., Sticca, R., Sugarbaker, P., Levine, E., Yan, T. D., Alexander, R., … & Berthet, B. (2009). Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal carcinomatosis of colorectal origin: A consensus statement. Cancer Journal, 15(3), 196–201
- Augusta Victoria Hospital. (n.d.). Oncology department reports and institutional updates. East Jerusalem: Augusta Victoria Hospital.
- MENA HIPEC Collaborative Group. (2020–2024). Regional outcomes and implementation trends of hyperthermic intraperitoneal chemotherapy in the Middle East and North Africa. Unpublished report.”
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