Peritoneal surface oncology · UK
HIPEC (heated intraperitoneal chemotherapy), private in London.
Cytoreductive surgery (CRS) followed by heated chemotherapy at 41 to 43 degrees Celsius delivered directly into the peritoneal cavity, for pseudomyxoma, peritoneal mesothelioma, and selected colorectal, ovarian and gastric peritoneal disease. Delivered in one of the small number of UK peritoneal malignancy centres, by a named consultant.
Why patients choose us
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A named peritoneal-surface surgical oncologist
Not a general surgical list. A consultant with a high annual CRS and HIPEC case volume, in one of the small number of UK peritoneal malignancy centres.
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A true peritoneal MDT before you commit
PCI scoring on CT and staging laparoscopy, histology review, medical oncology input, and an honest read on whether CRS and HIPEC is the right call.
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Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
What HIPEC is
Heated chemotherapy, delivered directly into the abdomen.
HIPEC is the second half of a single, long operation. Cytoreductive surgery (CRS) comes first.
HIPEC stands for heated intraperitoneal chemotherapy. It is a form of chemotherapy that is not given into a vein: instead, once the surgeon has removed all visible cancer from the abdomen, chemotherapy warmed to 41 to 43 degrees Celsius is circulated through the peritoneal cavity for 30 to 90 minutes. The heat improves the chemotherapy's penetration into any microscopic residual disease and increases its cytotoxic effect. Nothing about HIPEC is quick or standalone: it only makes sense when it follows a complete cytoreduction.
The cytoreductive surgery itself (CRS) is a 6 to 10 hour operation to peel affected peritoneum off the abdominal wall and organs, and to remove any organs invaded by tumour. It may include omentectomy, splenectomy, cholecystectomy, partial gastrectomy, small-bowel or colonic resection, and stripping of the diaphragmatic peritoneum. The target is either CC-0 (no visible residual disease) or CC-1 (residual nodules under 2.5 mm). Only when that target is reached does HIPEC follow.
Indicative pricing
What CRS and HIPEC costs privately in the UK.
Indicative ranges across our partner peritoneal centres. Send imaging and histology and we quote firm all-inclusive figures.
In short
A full CRS and HIPEC pathway in our network: £65,000 to £110,000, all-inclusive.
| Pathway | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Peritoneal MDT review and staging opinion | £1,200 to £2,400 | 2 weeks | Written report |
| Staging laparoscopy with PCI assessment | £6,500 to £11,000 | 45 to 90 min | Day case |
| CRS and HIPEC, low complexity (PCI <10) | £65,000 to £85,000 | 8 to 10 hours | All inclusive |
| CRS and HIPEC, standard (PCI 10 to 20) | £75,000 to £95,000 | 10 to 12 hours | All inclusive |
| CRS and HIPEC, high complexity (multi-visceral) | £90,000 to £110,000 | 12 to 14 hours | All inclusive |
| Second-opinion review of prior imaging and histology | £450 to £850 | 30 min | 5 working days |
Prices vary by centre, by the complexity of the cytoreduction required (single or multi-visceral resection), by ICU length of stay, and by the HIPEC agent used. We come back with a firm all-inclusive quote within two working days.
The journey
From MDT to surveillance, what happens, in order.
One team, from first message, through the 10-hour combined operation, to CT and marker surveillance.
- 01
Before
You send us the imaging and histology
A short, confidential form. Cross-sectional imaging, the histology report, prior operative notes, and current bloods where available.
- 02
Before
We come back with a recommendation
Within two working days: whether CRS and HIPEC fits, whether staging laparoscopy is needed first, or whether systemic therapy or PIPAC is the better call.
- 03
Before
Peritoneal MDT and prehab
Formal peritoneal MDT discussion. Anaesthetic assessment, nutritional optimisation, iron correction, and a four to six week prehab window where time allows.
- 04
On the day
CRS: the cytoreductive phase
A 6 to 10 hour operation to remove all visible tumour: peritonectomy, multi-organ resections, omentectomy, and any bowel or diaphragm resection required to reach a complete cytoreduction (CC-0 or CC-1).
- 05
On the day
HIPEC: the heated chemotherapy phase
Once cytoreduction is complete, heated chemotherapy at 41 to 43 degrees Celsius is circulated through the open or closed abdomen for 30 to 90 minutes, depending on agent and disease.
- 06
On the day
ICU and step-down
One to three nights in ICU or HDU, then step-down to the ward. Nasogastric tube, urinary catheter, drains, epidural analgesia and enhanced-recovery protocols.
- 07
After
Ward stay, discharge and surveillance
Ten to twenty-one days in hospital in total. Histology of the complete specimen in two to three weeks. CT and tumour-marker surveillance every three to four months for the first two years.
Indications
When CRS and HIPEC helps, and when it does not.
The primaries and disease burdens where CRS and HIPEC is the right operation, and the settings where it clearly is not.
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Pseudomyxoma peritonei (appendiceal)
Mucinous disease from a low or high-grade appendiceal neoplasm. The best-established indication for CRS and HIPEC, with the strongest long-term survival.
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Peritoneal mesothelioma
Diffuse malignant peritoneal mesothelioma without extra-abdominal spread. CRS with cisplatin-based HIPEC is the current standard for selected cases.
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Colorectal peritoneal metastases (PCI <20)
Isolated peritoneal disease from colon or rectal cancer, favourable biology, PCI under 20, with complete cytoreduction achievable.
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Recurrent ovarian cancer
Selected platinum-sensitive recurrent ovarian cancer at the time of secondary cytoreduction, per current European guidance.
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Selected gastric peritoneal disease
Low-volume peritoneal disease from gastric cancer, in trial or centre protocols only. Outcomes remain guarded and selection is strict.
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Peritoneal disease from rare primaries
Goblet-cell adenocarcinoma, small-bowel adenocarcinoma and desmoplastic small round-cell tumour in tightly selected cases.
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Extra-abdominal spread excludes CRS and HIPEC
Liver metastases beyond a small resectable number, lung, bone or brain disease. HIPEC treats the peritoneal cavity, not systemic disease.
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PCI >20 in colorectal disease
A peritoneal cancer index above 20 in colorectal primaries drives 5-year survival below 20 percent. We do not push CRS and HIPEC in that setting.
Chemotherapy agents and techniques
HIPEC is not one drug or one technique.
The agent, temperature and duration are chosen to match the primary tumour. The delivery technique is chosen by the centre.
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Mitomycin C HIPEC (colorectal, appendiceal)
Mitomycin C at 30 to 60 minutes remains the standard agent for colorectal and appendiceal peritoneal disease in most UK centres.
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Oxaliplatin HIPEC
Oxaliplatin over 30 minutes is used in some colorectal protocols, though PRODIGE 7 has tempered enthusiasm. Selection is centre-specific.
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Cisplatin plus doxorubicin HIPEC (ovarian)
Cisplatin combined with doxorubicin for 90 minutes is the standard for ovarian HIPEC at interval or secondary cytoreduction.
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Cisplatin HIPEC (mesothelioma)
Cisplatin, sometimes combined with doxorubicin, for peritoneal mesothelioma. Delivered at 42 to 43 degrees Celsius over 60 to 90 minutes.
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Open (coliseum) technique
The abdomen is left open under a plastic drape and the surgeon stirs the perfusate by hand. Better thermal homogeneity, slightly higher chemotherapy exposure to theatre staff.
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Closed technique
The abdomen is closed and perfusate circulated at pressure. Better staff protection and higher intra-abdominal pressure, which some data suggest improves drug penetration.
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PIPAC as an alternative or bridge
Pressurised intraperitoneal aerosol chemotherapy is a laparoscopic, palliative-intent option for patients not fit for CRS and HIPEC, or where PCI is too high.
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Systemic chemotherapy alone
For extra-abdominal disease, PCI above threshold, or patients unfit for a 10-hour operation, systemic therapy remains the standard of care.
Outcomes
Survival by primary and by disease burden.
The strongest predictors of long-term survival are the primary tumour, the peritoneal cancer index (PCI), and completeness of cytoreduction.
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Pseudomyxoma peritonei
Five-year survival of 65 to 80 percent in low-grade appendiceal disease with complete cytoreduction. The benchmark indication.
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Peritoneal mesothelioma
Five-year survival of 40 to 50 percent in selected patients with epithelioid histology and complete cytoreduction.
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Colorectal, PCI under 20
Five-year survival of 40 to 50 percent with complete cytoreduction and favourable biology. Adjuvant systemic therapy standard.
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Colorectal, PCI over 20
Five-year survival well below 20 percent. We do not push CRS and HIPEC in this setting; systemic therapy is preferred.
Where it is done
The small number of UK centres that do CRS and HIPEC properly.
Volume matters. CRS and HIPEC is done in a handful of accredited units in the UK. We work with these centres and their private-care arms.
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Basingstoke Peritoneal Malignancy Institute Private Care
The UK national centre for pseudomyxoma peritonei and the highest-volume CRS and HIPEC service in the country. Consultant-led, with dedicated peritoneal MDT and pathology.
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The Christie Private Care, Manchester
National peritoneal tumour service embedded within a specialist cancer hospital, with access to trials, PIPAC and systemic therapy pathways.
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HCA at The Harley Street Clinic and London Bridge Hospital
Private CRS and HIPEC in London, delivered by consultants who also operate within NHS peritoneal centres, with HCA level 3 ICU support.
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Royal Surrey Peritoneal Malignancy Unit, Guildford
Regional peritoneal centre with private capacity, offering CRS and HIPEC for appendiceal, colorectal and mesothelioma disease.
Selection
How we work out whether CRS and HIPEC is right for you.
Four questions decide the recommendation. Any red answer, and we recommend systemic therapy, PIPAC, or best supportive care instead.
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PCI score by CT and laparoscopy
A peritoneal cancer index of 0 to 39, worked up on cross-sectional imaging and confirmed at staging laparoscopy. Higher PCI, poorer outcomes.
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Formal peritoneal MDT decision
A surgical oncologist, medical oncologist, radiologist and pathologist review the case together before any recommendation is made.
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Performance status ECOG 0 to 1
You need to be fit enough to withstand a 10-hour operation, a night or three in ICU, and 10 to 21 days in hospital.
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No extra-abdominal metastases
Liver metastases beyond a small resectable number, or any lung, bone or brain disease, exclude CRS and HIPEC in most protocols.
Safety and recovery
What to expect afterwards, honestly.
CRS and HIPEC is one of the most demanding elective operations in oncology. Volume, prehab and ICU support drive outcomes.
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ICU for one to three nights
Standard after a 10-hour operation with heated chemotherapy. Ventilator support is uncommon in fit patients but planned for.
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Hospital stay of 10 to 21 days
Longer with anastomotic issues, ileus or wound problems. Enhanced-recovery pathways aim for the lower end of that range.
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Major morbidity in 20 to 40 percent
Anastomotic leak, intra-abdominal collection, bleeding, pancreatitis, chest infection and haematological toxicity. Quoted honestly before consent.
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Ninety-day mortality of 1 to 4 percent
In high-volume centres. Higher for very complex resections, older patients and gastric disease. Volume matters.
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Bone-marrow suppression from HIPEC
Neutropenia and thrombocytopenia in the first two weeks, particularly with mitomycin C. Bloods checked twice weekly after discharge.
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Renal function from cisplatin
Cisplatin HIPEC needs careful intra-operative sodium thiosulfate rescue and hydration to protect kidney function.
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Prehab and nutrition matter
A four to six week prehab window with exercise, iron correction and nutritional supplementation lowers complication rates.
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Recovery to full activity in 3 to 4 months
Return to office work at 6 to 10 weeks, physical work later. Adjuvant systemic therapy, if planned, starts at 6 to 8 weeks.
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Red flags after discharge
Fever, severe abdominal pain, tachycardia, vomiting or wound discharge. Contact the unit or attend A&E the same day.
Recognised by major UK insurers
Cover for CRS and HIPEC varies by insurer, indication and centre. Usually funded when medically indicated at a recognised peritoneal centre. We confirm cover and pre-authorise before booking.
Frequently asked
Everything we get asked about CRS and HIPEC.
Quick answers on recovery, survival, repeat HIPEC, insurance, exclusion criteria, and the peritoneal MDT.
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How long does recovery from CRS and HIPEC take?
Expect 10 to 21 days in hospital in total, including one to three nights in ICU. Return to office work is typical at 6 to 10 weeks, and full return to physical activity at 3 to 4 months. Adjuvant systemic therapy, if planned, usually starts at 6 to 8 weeks. Prehab in the weeks before surgery meaningfully shortens the recovery curve.
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What are the survival figures after CRS and HIPEC?
The five-year survival depends heavily on primary and disease burden. Pseudomyxoma peritonei from a low-grade appendiceal neoplasm reaches 65 to 80 percent at five years. Peritoneal mesothelioma sits at 40 to 50 percent in well-selected cases. Colorectal peritoneal disease with a PCI under 20 and complete cytoreduction reaches 40 to 50 percent. Above a PCI of 20 in colorectal disease, five-year survival falls well below 20 percent.
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Can HIPEC be repeated if disease comes back?
Repeat CRS and HIPEC (iterative HIPEC) is possible in carefully selected patients, most often in pseudomyxoma and low-grade appendiceal disease. It is not standard in colorectal or ovarian recurrence, where systemic therapy or PIPAC is usually preferred. The decision goes back to the peritoneal MDT.
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Will private medical insurance cover CRS and HIPEC?
Cover varies. Most UK insurers will fund CRS and HIPEC when it is medically indicated in an accepted primary (pseudomyxoma, colorectal PCI under 20, ovarian recurrent, mesothelioma) at a recognised peritoneal centre. Pre-authorisation is essential and we handle the paperwork. Some insurers cap the theatre or hospital element and top-up may be needed for very complex cases.
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Why does extra-abdominal disease exclude CRS and HIPEC?
HIPEC only treats the peritoneal cavity. Liver metastases beyond a small number of resectable lesions, or any lung, bone or brain disease, mean systemic disease that heated intraperitoneal chemotherapy cannot reach. In that setting a 10-hour operation carries the morbidity of surgery without the survival benefit, so we recommend systemic therapy instead.
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Do I really need a peritoneal MDT decision?
Yes. CRS and HIPEC is one of the most morbid elective operations in oncology, and patient selection is what drives outcomes. A formal peritoneal MDT with a surgical oncologist, medical oncologist, radiologist and pathologist reviewing PCI on imaging (and often at staging laparoscopy) is the single most important quality step. We insist on it before any recommendation.
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Talk to us about CRS and HIPEC
Send the imaging and histology. We come back within two working days.
An honest read on whether CRS and HIPEC is the right operation for you, which UK peritoneal centre fits best, and a firm all-inclusive quote across two or three options.