General Surgery

by Prof. Mahir Özmen, M.D.

Hyperthermic Intraperitoneal Chemotherapy HIPEC is a per-operative chemotherapy technique applied during a surgical oncology procedure. By this cytoreductive surgery, tumor on the wall of peritoneum is removed, sometimes including organ resections of colon, partial stomach, gall bladder, uterus or ovaries


Prof. Mahir Özmen, M.D.

General Surgery


Standard chemotherapy or post-operative intravenous chemotherapy may not sufficiently reach and affect peritoneum because of anatomical and physiologic structure of this tissue. So HIPEC provides a direct reach to the tissue and helps to reach the ultimate goal of the procedure which is to reach R0 resection where no tumor is left behind.

Who can benefit ?

The selection of patients to consider HIPEC depends on a few factors. The first one is there shouldn’t be metastasis to other organ systems other than abdomen. Another factor is the patient’s physical capacity to tolerate this intra-operative procedure. Lastly the Peritoneal Cancer Index that calculates the spread of cancer in peritoneum is taken into consideration by the surgeon before deciding on HIPEC.


Although known since 30-35 years, HIPEC became more popular in the recent years. It has proven to be effective compared to regular chemotherapy in specific kinds of cancers. This advantage arises from three main areas:

  • The first issue is that patients are irritated by the toxicity of standard chemotherapeutic treatments. However with HIPEC treatment, the agents are delivered directly into the abdominal cavity and doesn’t enter the whole body’s circulation system, thus minimizing the risks of toxicity.
  • Another concern for many patients is the time span of the therapeutic process which usually takes several sessions over weeks, sometimes months. HIPEC on the other hand is usually administrated during a single treatment which explicitly implies less expenses, less visits to the doctor and less time off the normal course of life.
  • Statistical records and rates can also rise worries when it comes to alternative treatments. But not in the case of HIPEC, since recent reports show that patients diagnosed with mesothelioma at the early stages of cancer development, have higher life expectancy after treatment that even can double.

Points to Consider

Cytoreductive surgery itself is generally a long time consuming procedure. The additional extension of surgery time because of HIPEC has some indication on the patients such as increasing hospital stay for a few days more. But this disadvantage is balanced with being able to use lower doses of chemotherapy in HIPEC. Nevertheless a patient who underwent HIPEC treatment should stay in Turkey for at least 2 weeks after the surgery.  

Prof. Mahir Özmen, M.D.

General Surgery
  • Medical School, Ankara University – Turkey
  • General Surgery, Ankara University- Turkey
  • Master of Surgery, Southampton University – England
  • Hacettepe University -Turkey
  • Professor since 2010
  • Sub-specialty on Surgical Oncology 2012
  • Works in İstanbul and Ankara
  • Liv Hospital Group

Prof. Mahir Özmen is one of the highly acknowledged Oncosurgeons of Turkey alongside his academic accomplishments that makes him a recognized international surgeon. He has published over 200 research papers with 4000 citations that carry himself to a very high H-index which is an international measure of academic performance.

He holds many international titles including the American Society of Metabolic and Bariatric Surgery (ASBMS), Fellow of Royal College of Surgeons Glasgow FRCSİ, Fellow of European Board of Surgery FEBS, etc. and acts as an international teaching and governing surgeon who trains surgeons from all around the world.

Prof. Özmen speaks about the surgical oncology procedure and he actually divides into two main categories, tumors in the upper GI (gastrointestinal) and tumors in the lower GI due to different surgical approach and techniques. Whatever the type of surgery is, the target of it should be to create a tumor-free resection (R0) where the surgeon leaves no cells of tumor behind.

If it is R1, it means micro-tumors are left behind where you can’t see the tumor left behind with the naked eye and if it is R2 it means you can still see the tumor left behind. In these cases, radio or chemotherapy is required after the initial procedure. So Prof. Mahir Özmen specifies his main goal is curative surgery, which means to do extensive surgery in order to leave no tumor behind.

Among surgical oncology procedures, Prof. Mahir places great importance on HIPEC, being an advanced treatment option especially for advanced gastrointestinal tumors and gynecological tumors. HIPEC is required for stage 3 and stage 4 patients with peritoneal deposits and layers of the internal abdomen are removed in a prior procedure named ‘Peritonectomy’ that separates the abdomen from the peritoneum. Then special HIPEC agents are applied inside the abdomen to decrease the chances of metastasis.

Prof. Mahir Özmen states that HIPEC can be done via laparoscopic procedure but he prefers open surgery for HIPEC at which he can perform extensive surgery.

“Yes, the number of cases of the surgeon who perform the procedure is very important, but it is not everything”

Although he has performed a huge number of cases in oncosurgery, Prof. Mahir Özmen prefers to emphasize the importance of “being complete” rather than being “only a technician”, underlying reading, writing, and strengthening the academic side.

“You need Best Surgeon, very well-equipped hospital, a talented and well-educated team of surgery in order to overcome any complications”

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