Good Doctor · Hyperthermic Perfusion | Exploring the Microscopic World of “Hyperthermic Perfusion”

The key to determining the success or failure of hyperthermic intraperitoneal chemotherapy and accounting for differences in therapeutic outcomes lies in the comprehensive implementation of the entire hyperthermic perfusion treatment protocol. Good Doctor (GDHIPEC) delves into clinical details, refines its proprietary technologies, and exercises closed-loop management over every stage of the treatment course, thereby ensuring stable clinical efficacy. From selecting the perfusion solution, optimizing minimally invasive catheter placement, and devising diversified perfusion regimens, to adjusting device pressure, matching flow rates, and achieving high-precision temperature control—these critical steps are all meticulously addressed, providing all‑round support for the standardized application of clinical therapy. Leveraging the micro‑pharmacological mechanisms of hyperthermic perfusion, it delivers core therapeutic benefits in preventing and treating tumor implantation and metastasis, as well as alleviating malignant ascites.

Scientifically selecting an appropriate hyperthermic perfusion regimen based on the patient’s clinical condition is a crucial foundation for ensuring the smooth execution of perfusion and the safety and reliability of the entire treatment process.

Peritoneal tumor

Chinese Guidelines for Integrated Cancer Care (CACA)

2025

Figure: 2025 Edition of the “Peritoneal Tumors – Chinese Guidelines for Integrated Cancer Care (CACA)”

01 | Selection of Infusion Solutions |
 

Recommended for use: saline solution

The risks associated with saline in hyperthermic intraperitoneal chemotherapy are primarily related to procedural techniques—such as temperature and pressure control—as well as the patient’s underlying comorbidities and fluid management, rather than to saline itself. With standardized procedures, rigorous monitoring, and individualized adjustments, most of these risks can be effectively mitigated.

Figure: GDHIPEC recommends saline as the perfusion solution.

Distilled water should be used with caution in routine clinical practice due to the high risk of hypotonicity.

5% glucose solution may be used in specific clinical situations (such as in patients with cardiac or renal insufficiency who require sodium restriction), but careful monitoring of changes in osmolality and the risk of infection is essential, with electrolyte supplementation added as needed.

Comparison between ascitic fluid and normal saline

Theoretical advantages of the native ascites circulation: The electrolytes, proteins, and osmotic pressure of native ascites are consistent with the body’s internal environment, which can reduce peritoneal irritation and preserve endogenous immune factors such as complement and antibodies, potentially exerting a local antitumor effect.

Key risks: Unprocessed ascitic fluid contains free cancer cells, and residual pro‑tumorigenic factors such as VEGF can accelerate tumor progression. Moreover, the original ascitic fluid is rich in proteins, providing an excellent growth medium; bacterial contamination may further precipitate sepsis.

Advantages vs. Limitations

Physiological Saline Circulation Analysis

Core strengths: Sterile saline is free of tumor cells and pro‑cancer factors, and standardized procedures can reduce complications. It does not interfere with chemotherapeutic agents, is easy to administer, requires no handling of body fluids, and saves time and costs.

Obvious limitations of existence: A deficiency of physiological proteins increases peritoneal permeability and exacerbates protein leakage. Large-volume infusions are detrimental to patients with cardiopulmonary dysfunction and may precipitate associated systemic complications.
 

The paradox of ascites and protein levels

Short-term contradictions: Cancer cells and other components in ascitic fluid pose significant risks; they are difficult to retain within the peritoneal cavity and even more challenging to return to the systemic circulation. Even after filtration and purification, reinfusion can reduce protein loss, but this approach is technically demanding and economically inefficient.

Long-term risks persist: Residual cancer cells or factors within the peritoneal cavity can accelerate tumor growth and ascites recurrence, increase the likelihood of adhesions and encapsulation, and lead to tube obstruction. These conditions impose persistent adverse effects on the patient’s body and hinder disease stabilization.
 

Saline and Protein Management

Short-term protein loss: Peritoneal drainage of ascites, performed concurrently with the removal of malignant ascites, leads to changes in osmotic pressure and, due to the continuous production of ascitic fluid, promotes the loss of albumin.

Long-term benefits: HIPEC can maintain a constant temperature within the abdominal cavity, which promotes the formation of a membranous coagulum on the peritoneal surface. This membranous coagulum prevents proteins from continuing to leak from the vasculature into the peritoneal space, thereby halting further protein loss and even leading to an increase in plasma protein levels.

Protein Management Strategy:

Intraoperative effective control: Controlled perfusion of the peritoneal cavity at an effective therapeutic temperature of 42°C for 60 minutes promotes the formation of a protein‑crosslinked membrane on the peritoneal surface, thereby maintaining peritoneal integrity.

Appropriate postoperative management: For patients with hypoproteinemia, administer intravenous albumin during the 24 hours before and after surgery, provide a high-protein diet supplemented with branched-chain amino acids to promote protein synthesis, and use short-term glucocorticoids to inhibit protein catabolism.

Special management of ascites: A unidirectional perfusion technique is employed to manage native ascites. Specifically, this method involves replacing the ascitic fluid within the body cavity while maintaining a constant volume but altering its composition, thereby providing an effective approach for treating refractory ascites.

Image: Good Doctor models GDPR-2100S and GDPR-2100T
 

With more than two decades of dedicated expertise in the field of intracavitary hyperthermic perfusion, Good Doctor Hyperthermic Perfusion has consistently placed patient safety and clinical efficacy at its core. Leveraging multiple proprietary core technologies, a well-established clinical adaptation system, and an exceptionally low barrier to implementation, it effectively mitigates the various risks associated with empirical conventional hyperthermic perfusion therapies. It addresses longstanding industry challenges such as unstable temperature fluctuations, imbalances in intracavitary pressure, incomplete fluid exchange, and difficulties in adapting treatment for special patient populations. With advantages in precision, intelligence, and standardization, it provides clinical treatment protocols for medical institutions at all levels, aimed at “treating or preventing tumor implantation and metastasis, and controlling malignant effusions.”