HIPEC surgery is complex and arduous, often lasting 12 hours or more. Given the intensity of the procedure and the likely need to travel to one of the 27 states that boast of an expert, those who pursue such treatment tend to be highly motivated, younger, healthier, and wealthier. These patients also tend to use the militaristic lexicon that often accompanies a cancer diagnosis -- "fighting a war,""winning a battle,""not giving up." Dr. Sugarbaker is their ally in that war.

In more than a decade of treating patients with gastrointestinal tumors, I have had more than a dozen proceed with this approach and another handful who wished to but were turned down by surgeons. Did these patients who received HIPEC benefit from this surgery? No one has been cured, some may have lived longer than they would have without it, and some undoubtedly suffered as a result. Over these 10 years, there have been advances in chemotherapy that have allowed patients longer lives, as hoped for with this surgery.

Unfortunately, in the war on cancer, a chance at a cure is the only acceptable option for most. Simply living longer doesn't cut it.

The scientific merit of HIPEC has been discussed and debated eloquently by others. When I speak with patients considering this surgery, I encourage them to identify their goals and consider their definition of an acceptable outcome. These are motivated people who desperately want to be well again, and they see the chance of a cure in their sights. I ask them what they have heard from their surgeon, and many say things like "He thinks he can get it all," or echo the hollow statistical report: "There's a 50 percent chance." To which I always reply, "Chance of what?"

The reality is that the majority of these patients will not be cured and will continue living with cancer. In the best of cases, when that cancer returns, devastating disappointment ensues. Still, most patients resume chemotherapy just as before, with no regrets for having gone through this surgery. In the worst of cases, patients never recover, experience continued wasting, suffer bowel obstructions, and endure misery for the remainder of their lives.

Regret is a terrible emotion to live with, as well as an often unbearable feeling for caregivers and loved ones that can linger long past a patient's death. In our Western culture, regret is most commonly associated with not doing something or missing out on some opportunity. As Mark Twain said, "Twenty years from now, you will be more disappointed by the things that you didn't do than the ones you did do." To turn down a chance at a cancer cure is unthinkable.

My job is to arm patients with the information they need so they make a thoughtful decision and move forward with no regrets. If the goal is curative, I encourage them to ask their surgeon, "What are the chances that this is going to cure me?" If cure is not the goal, I want to ensure they have a clear understanding of this surgery's benefits. Will undergoing HIPEC prolong life? Will HIPEC improve quality of life? These are simple, pertinent questions that, unfortunately, often go unasked.