Complex Peritoneal Surface Malignancy Surgery (HIPEC) Course

Lesson 1 • Classification of Peritoneal Malignancies

Defines primary and secondary peritoneal tumors by origin, histology, and behavior. Enables accurate diagnosis and selection of appropriate treatment pathways.

Lesson 2 • Peritoneal Anatomy and Physiology

Covers gross and microscopic peritoneal structure, fluid dynamics, and lymphatic drainage. Provides the anatomical framework required for understanding tumor spread patterns.

Lesson 3 • Biology of Peritoneal Metastasis

Explains mechanisms of peritoneal seeding, implantation, and tumor microenvironment interactions. Links molecular biology to clinical behavior and treatment resistance.

Lesson 4 • Multidisciplinary Evaluation Framework

Outlines the roles of oncology, radiology, pathology, and surgery in patient evaluation. Establishes the collaborative decision-making model used throughout the course.

Lesson 1 • Eligibility Criteria for CRS-HIPEC

Defines oncologic, physiologic, and technical criteria that determine patient suitability. Applies evidence-based thresholds to avoid futile surgery and patient harm.

Lesson 2 • Nutritional Optimization Before Surgery

Addresses malnutrition screening, prehabilitation, and enteral or parenteral support protocols. Nutritional optimization reduces anastomotic failure and postoperative morbidity.

Lesson 3 • Cardiopulmonary and Functional Risk Assessment

Teaches physiologic risk stratification using cardiac, pulmonary, and functional testing. Risk quantification guides anesthetic planning and intraoperative management strategies.

Lesson 4 • Preoperative Imaging and Staging Workup

Covers CT, MRI, PET-CT, and diagnostic laparoscopy for disease mapping. Accurate imaging interpretation prevents unnecessary laparotomy and guides surgical planning.

Lesson 1 • Hemostasis and Vascular Control

Addresses bleeding control strategies during extensive peritoneal dissection and visceral resection. Effective hemostasis reduces transfusion requirements and operative mortality.

Lesson 2 • Peritonectomy Procedures by Region

Teaches systematic peritoneal stripping of the anterior wall, diaphragm, pelvis, and retroperitoneum. Regional sequencing ensures complete exposure and minimizes missed disease.

Lesson 3 • Intraoperative Assessment and Decision Points

Teaches real-time evaluation of resectability, frozen section use, and abort criteria. Intraoperative judgment prevents futile completion and guides safe surgical endpoints.

Lesson 4 • Visceral Resections in Cytoreduction

Covers splenectomy, cholecystectomy, bowel resection, and urologic procedures performed during CRS. Integrates visceral resection into the overall cytoreductive strategy safely.

Lesson 1 • Platinum-Based HIPEC Regimens

Details cisplatin and oxaliplatin dosing, carrier solutions, and histology-specific indications. Platinum agents form the backbone of most HIPEC protocols across tumor types.

Lesson 2 • Hyperthermia Mechanisms and Drug Synergy

Covers thermal cytotoxicity, heat-enhanced drug uptake, and DNA repair inhibition. Hyperthermia is not merely a carrier but an active therapeutic component of HIPEC.

Lesson 3 • Pharmacokinetic Basis of HIPEC

Explains the peritoneal-plasma barrier, drug exposure advantage, and concentration-time relationships. Pharmacokinetic understanding underpins all drug dosing and scheduling decisions.

Lesson 4 • Emerging and Investigational HIPEC Agents

Reviews taxanes, targeted agents, and immunotherapy combinations under clinical investigation. Awareness of emerging agents prepares surgeons to participate in and evaluate future trials.

Lesson 1 • Open Coliseum Technique

Teaches the Sugarbaker open technique with manual distribution and thermal monitoring. The open method allows direct tumor manipulation and real-time distribution assessment.

Lesson 2 • Closed Abdomen Perfusion Technique

Covers closed-technique catheter placement, abdominal closure, and pressure monitoring. The closed method reduces staff exposure and may improve thermal uniformity.

Lesson 3 • Thermal Uniformity and Flow Optimization

Addresses achieving homogeneous temperature distribution across all peritoneal regions. Thermal heterogeneity reduces efficacy and increases risk of local under-treatment.

Lesson 4 • HIPEC Equipment and Circuit Configuration

Describes perfusion machines, heat exchangers, roller pumps, and temperature probes. Correct equipment setup is prerequisite to safe and reproducible HIPEC delivery.

Lesson 1 • Fluid Management and Hemodynamic Support

Teaches goal-directed fluid therapy, vasopressor use, and cardiac output monitoring during CRS-HIPEC. Fluid balance directly affects anastomotic healing and postoperative renal function.

Lesson 2 • Anesthetic Considerations for CRS-HIPEC

Outlines the physiologic demands of prolonged surgery, hyperthermia, and large fluid shifts. Anesthetic planning must anticipate thermal, hemodynamic, and coagulation challenges simultaneously.

Lesson 3 • Renal and Metabolic Protection Strategies

Covers nephroprotection during cisplatin-based HIPEC, electrolyte management, and glucose control. Renal protection protocols reduce acute kidney injury incidence in high-risk patients.

Lesson 4 • Coagulation Management and Transfusion

Addresses coagulopathy prevention, point-of-care coagulation testing, and transfusion triggers. Coagulation management is critical given extensive dissection and thermal effects on clotting.

Lesson 1 • Critical Care and ICU Management

Covers ICU admission criteria, ventilatory support, and organ failure management after complex CRS-HIPEC. Intensive care expertise is essential for managing the highest-risk postoperative patients.

Lesson 2 • Hematologic and Renal Toxicity Management

Addresses chemotherapy-related myelosuppression, thrombocytopenia, and acute kidney injury after HIPEC. Toxicity management protocols reduce treatment-related mortality in the postoperative period.

Lesson 3 • Anastomotic and Surgical Site Complications

Covers anastomotic leak diagnosis, fistula management, and wound complication treatment. Early recognition and appropriate intervention prevent sepsis and prolonged hospitalization.

Lesson 4 • Enhanced Recovery After CRS-HIPEC

Adapts enhanced recovery principles to the unique demands of cytoreductive surgery. Structured recovery pathways reduce length of stay without compromising safety.

Lesson 1 • Learning Curve and Surgical Training

Quantifies the CRS-HIPEC learning curve and identifies training milestones for competency. Structured training pathways accelerate safe skill acquisition and reduce preventable complications.

Lesson 2 • Research Design and Clinical Trial Participation

Prepares surgeons to design institutional studies and participate in multicenter peritoneal oncology trials. Research participation advances the field and improves local program credibility.

Lesson 3 • Quality Metrics and Benchmarking

Defines process and outcome metrics for CRS-HIPEC programs and compares performance against benchmarks. Metric-driven practice identifies gaps and drives continuous quality improvement.

Lesson 4 • Building a Peritoneal Oncology Program

Covers institutional requirements, team assembly, equipment procurement, and credentialing for new programs. Structured program development reduces the learning curve and early program mortality.