Peritoneal malignancy · UK national centres
CRS-HIPEC in the UK, at the centres that do it well.
Cytoreductive surgery with heated intraperitoneal chemotherapy is one of the biggest operations in cancer care. It is NHS-commissioned at a handful of UK centres — Basingstoke, Christie, Hammersmith, Belfast, Cardiff — and we help you get to the right one.
Why patients choose us
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The right centre, not the nearest hospital
CRS-HIPEC is NHS-commissioned at a handful of national centres — Basingstoke, Christie, Hammersmith, Belfast, Cardiff. We help you get referred to the one whose case-mix matches your histology.
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An honest read on whether you qualify
Not every peritoneal disease benefits from HIPEC. We give you the peritoneal cancer index, the histology and the trial evidence in plain language — before the tertiary MDT.
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Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Cost and funding
CRS-HIPEC is NHS-funded. Getting to the right centre is where we help.
The operation itself is commissioned centrally by NHS England — you do not pay for it. Private CRS-HIPEC pathways in the UK are rare and we do not recommend them without a specific reason.
In short
The operation is NHS-funded via HSS at national centres. Our concierge referral service is free for patients.
| Step or option | Cost | Typical duration | Turnaround |
|---|---|---|---|
| CRS-HIPEC (NHS-commissioned) | NHS-funded via NHS England HSS | 8–14 hours | 4–6 wk in hospital |
| Peritoneal MDT referral (concierge fee) | Free with Pulse Atlas | 2 wk to MDT | MDT decision same week |
| Second-opinion consultation | £300–£600 | 45–60 min | Within 2 weeks |
| Diagnostic laparoscopy + PCI | NHS-funded at centre | 60–90 min | Day case |
| PIPAC (palliative / bridging) | NHS-funded, select centres | 30–45 min | Repeatable every 6 wk |
| CT chest/abdo/pelvis (staging) | £600–£1,100 private | 30 min | Report 24–48 h |
A private second opinion or a private staging CT is often useful for peace of mind or to move quickly — but the operation itself belongs at an NHS-commissioned centre. We confirm the route within two working days.
The problem
The right centre, the right histology, the right honest read.
Peritoneal cancer pathways go wrong in three familiar ways — the wrong hospital, the wrong indication, or a family told nothing about PIPAC when CRS-HIPEC is not on the table. We fix all three before the MDT.
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Not sure you qualify?
PCI, histology and fitness all matter. We give you the honest read before the tertiary MDT sees you.
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Not sure which centre?
Basingstoke, Christie, Hammersmith, Belfast and Cardiff each have a different case-mix. We route the referral to the one that fits your histology.
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Told nothing about PIPAC?
If full CRS-HIPEC is not the right step, PIPAC — pressurised aerosolised chemotherapy — is often available. We make sure it is discussed.
The journey
From enquiry to recovery — what happens, in order.
A named point of contact from first message through MDT decision, admission and surveillance.
Phase 1 · Before your operation
Concierge, off-stage for you
Phase 2 · Admission and inpatient stay
4–6 weeks in hospital
Phase 3 · After
Concierge, back on
- 01
Before
You tell us what is going on
Diagnosis, imaging, histology, previous treatment. We ask for the pathology report and the most recent CT.
- 02
Before
We come back with a view
Within two working days: whether CRS-HIPEC is a realistic option, which UK centre fits, what the MDT will want to see.
- 03
Before
Referral into a peritoneal MDT
We route the referral to Basingstoke, Christie, Hammersmith, Belfast or Cardiff — with the imaging, histology and CPET the centre needs.
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Inpatient
Admission and the operation
A full day in theatre — 8 to 14 hours. Cytoreduction first, HIPEC last. Recovery starts in intensive care.
- 05
Inpatient
ITU and HDU
Three to seven days in intensive care, then three to five on a high-dependency unit — this is the recovery phase everyone underestimates.
- 06
Inpatient
The ward, then home
Three to four weeks on the ward, often with nasogastric feeding or TPN. Discharge is deliberate and slow.
- 07
After
Follow-up and surveillance
CT and tumour markers at set intervals — schedule depends on histology. We keep you in touch with the centre.
Typical end-to-end: 4–8 weeks from enquiry to operation. Full recovery: 6–12 months.
When it helps
When CRS-HIPEC is the right operation.
The peritoneal cancers we see most, and the honest picture of when CRS-HIPEC is not the right step.
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Pseudomyxoma peritonei (PMP)
From a ruptured appendiceal mucinous neoplasm. The gold-standard indication — Basingstoke reports 10-year survival of 75–85% with complete cytoreduction.
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Peritoneal mesothelioma
Cytoreduction plus HIPEC improves survival compared with systemic chemotherapy alone; 5-year survival around 50% in selected patients.
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Ovarian peritoneal disease
Interval CRS-HIPEC after neoadjuvant chemo — OVHIPEC-1 (NEJM 2018) showed median OS 45.7 vs 33.9 months in selected cases.
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Colorectal peritoneal metastases
CRS remains standard for oligometastatic peritoneal disease. HIPEC benefit is controversial post-PRODIGE 7 — agent choice matters.
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Gastric peritoneal disease
Increasingly considered in select cases; PIPAC is often used as a bridge or alternative in higher-burden disease.
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Appendiceal adenocarcinoma
Non-mucinous appendiceal cancers with peritoneal spread — treated within the peritoneal-malignancy pathway alongside PMP.
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Peritoneal disease of unclear primary
Where histology or origin is uncertain, diagnostic laparoscopy with PCI and biopsies comes before any HIPEC decision.
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Red flag: not for HIPEC
Extensive extra-abdominal disease, PCI over 20–25, aggressive histology unlikely to benefit, or a body unfit for a 10-hour operation. Honest advice matters.
Procedure options
CRS-HIPEC is not the only option.
The techniques, the chemotherapy agents, and — for the wrong indication — the alternatives.
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Cytoreductive surgery (CRS)
Sugarbaker peritonectomy — greater omentectomy, quadrant peritonectomies, pelvic clearance, and any bowel resection needed to remove all visible disease.
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HIPEC — closed technique
Abdomen closed; chemotherapy perfused through drains at 41–43°C for 60–90 minutes. The most common UK delivery method.
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HIPEC — open (Coliseum) technique
Abdomen left open with a plastic containment; the surgeon manually distributes the heated chemotherapy for even coverage.
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Mitomycin C HIPEC
Standard agent for appendiceal and colorectal peritoneal disease — 12.5 mg/m² for 90 minutes.
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Cisplatin ± doxorubicin HIPEC
Preferred combination for ovarian cancer and peritoneal mesothelioma — perfused for 60–90 minutes.
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Oxaliplatin HIPEC
An alternative agent for colorectal peritoneal disease — shorter perfusion, different toxicity profile.
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PIPAC (aerosolised chemotherapy)
Pressurised intraperitoneal aerosol chemotherapy — a laparoscopic, repeatable alternative for patients unfit for full CRS-HIPEC. Belfast, Christie and Basingstoke offer it.
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Diagnostic laparoscopy + PCI
The essential staging step before any HIPEC decision — direct measurement of the peritoneal cancer index (0–39) across 13 abdominal regions.
The UK centres that do this operation
A handful of national centres, by design.
NHS England commissions CRS-HIPEC at a small number of high-volume centres so that outcomes stay at the level a specialist unit can deliver. We refer into the one that fits your case.
Referral criteria
How we choose which UK centre to refer you to.
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NHS-commissioned peritoneal malignancy centres only (Basingstoke, Christie, Hammersmith/Imperial, Belfast, Cardiff)
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A named consultant peritoneal surgeon with a specific interest in your histology
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A tertiary peritoneal MDT — upper GI, HPB, colorectal, gynae-oncology, medical oncology, radiology, histopathology
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PIPAC available on-site where CRS-HIPEC is not the right step
Safety and recovery
What to expect — honestly.
CRS-HIPEC is a genuinely major operation. This section is deliberately blunt about mortality, complications, and long-term effects. It should be — the decision needs it.
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30-day mortality 2–5% at specialist centres
CRS-HIPEC is genuinely major surgery. Mortality is higher in low-volume units — this is exactly why NHS England commissions it at a handful of national centres.
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Grade III–IV complications 30–50%
Anastomotic leak 5–15%, pancreatic or chyle leak, bleeding, sepsis, respiratory failure, AKI, DVT/PE. Half of patients have a significant complication, most recover.
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ITU stay 3–7 days is normal
Massive fluid shifts, a catabolic state and prolonged ileus mean intensive care is planned, not a rescue. HDU follows for another 3–5 days.
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Nasogastric drainage and TPN often needed
GI recovery is slow. Nutritional support — enteral or intravenous — is standard for the first two to three weeks.
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Chemotherapy toxicity is real
Neutropenia, renal impairment and mitomycin- or cisplatin-related cardiac toxicity all happen. Monitoring in the first week is close.
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Long-term adhesions and obstruction
Adhesive small-bowel obstruction, incisional hernia, chronic pain and altered bowel or bladder function are common longer-term issues.
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Sexual and hormonal effects
Pelvic peritonectomy — with occasional hysterectomy, oophorectomy or rectosigmoid resection — can affect sexual function, fertility and hormones. This is discussed at consent.
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Not routinely private in the UK
CRS-HIPEC is NHS-funded via specialised commissioning. Private CRS-HIPEC pathways in the UK are rare and we do not recommend them without a strong reason.
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Red flags after discharge
Fever, spreading abdominal pain, vomiting, wound discharge or reduced urine output — call the centre’s specialist nurse the same day, not next week.
Reading your operation note
Your CRS-HIPEC operation note in four parts. Read the last one first.
Whichever centre operates, the note the surgeon sends you keeps to the same shape — histology, PCI, completeness of cytoreduction, chemotherapy details, adjuvant plan.
A quiet reminder
Surgical language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Histology, PCI and completeness of cytoreduction (CC-0/1/2/3)
The three numbers that drive prognosis: what the tumour is, how much peritoneal disease there was (PCI 0–39), and how much was left behind (CC-0 is complete).
- 02 Technique
Peritonectomy procedures and resections performed
Which of Sugarbaker’s five peritonectomies were done, which organs were resected, and whether a stoma was formed. This maps directly to your recovery.
- 03 HIPEC
Agent, temperature, duration and delivery
The chemotherapy used (mitomycin C, cisplatin ± doxorubicin, oxaliplatin), the perfusate temperature, the duration and whether it was open or closed technique.
- 04 Impression
Adjuvant plan and surveillance schedule
Read this first: whether systemic chemotherapy follows, and the CT and tumour-marker schedule for surveillance.
Recognised by major UK insurers
CRS-HIPEC is NHS-commissioned via specialised services — private insurance is not usually the funding route. Private staging, second opinions and surveillance imaging are usually covered.
Frequently asked
Everything patients and families ask us about CRS-HIPEC.
Quick answers on centres, indications, PCI, recovery, complications and PIPAC as an alternative.
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What is HIPEC, in plain English?
HIPEC — hyperthermic intraperitoneal chemotherapy — is heated chemotherapy delivered directly into the abdominal cavity at the end of a long tumour-clearance operation called cytoreductive surgery (CRS). The two together are called CRS-HIPEC.
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Which UK centres do CRS-HIPEC?
CRS-HIPEC is NHS-commissioned via NHS England Specialised Services at a small number of centres: the Peritoneal Malignancy Institute at Basingstoke (the UK’s largest), The Christie in Manchester, Hammersmith/Imperial in London, Belfast City Hospital, and — for paediatric peritoneal malignancy via Cardiff — the wider Cardiff pathway. Case-mix varies by centre.
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Is CRS-HIPEC available privately in the UK?
Not routinely. It is a specialised, high-volume, low-volume-hospitals-do-poorly operation. NHS England commissions it centrally at the handful of centres above. We do not recommend private CRS-HIPEC pathways in the UK without a very specific reason.
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Which cancers does HIPEC help?
The strongest evidence is for pseudomyxoma peritonei (PMP) from a ruptured appendiceal tumour and for peritoneal mesothelioma. There is trial evidence for interval CRS-HIPEC in advanced ovarian cancer (OVHIPEC-1). For colorectal peritoneal disease, cytoreduction is standard but HIPEC benefit is debated after PRODIGE 7. Gastric peritoneal disease is a selected indication.
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What is the peritoneal cancer index (PCI)?
PCI is Sugarbaker’s 0–39 score of how much peritoneal disease you have across 13 abdominal regions. It is usually measured at diagnostic laparoscopy before CRS-HIPEC. A PCI above 20–25 is a relative contraindication because complete cytoreduction becomes unlikely.
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How long is recovery from CRS-HIPEC?
The operation itself is 8 to 14 hours. Expect three to seven days in intensive care, three to five on HDU, and three to four weeks on the ward. Full recovery — energy, weight, bowel function — takes six to twelve months.
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What are the risks?
This is major surgery. 30-day mortality is 2–5% at specialist centres. Grade III–IV complications occur in 30–50% of patients — anastomotic leak, bleeding, sepsis, respiratory failure, AKI and chemotherapy toxicity are the main ones. Long-term issues include adhesive obstruction, hernia and altered GI or sexual function.
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What if I am not fit for CRS-HIPEC?
PIPAC — pressurised intraperitoneal aerosol chemotherapy — is a laparoscopic, repeatable alternative used palliatively or as a bridge. Belfast, Christie and Basingstoke offer it. It is not curative, but for the right patient it controls disease with a fraction of the physiological hit.
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