| Patient Characteristic | Details |
| Patient | Gail Croney |
| From | Barbados |
| Diagnosis | Appendicular Cancer |
| Prior Treatment | 12 Cycle of Chemotherapy |
| Procedure | HIPEC (Hyperthermic Intraperitoneal Chemotherapy) combined with cytoreductive surgery |
| Hospital | Shalby International Hospital, Gurugram, India |
| Surgeon | Dr. Piyush Kumar Agarwal |
| Outcome | Surgery successful. Recovered in India. Returned home to Barbados. |
Barbados. Twelve rounds of a treatment that takes everything from you before it gives you a fighting chance. She had done all of it, and she had done it at home, supported by her doctors and her family, as close to normal life as chemotherapy allows.
And then her oncology team told her she needed HIPEC.
Hyperthermic Intraperitoneal Chemotherapy combined with cytoreductive surgery is one of the most specialised procedures in surgical oncology. It is not available in Barbados. It is not available across most of the Caribbean. For patients with peritoneal spread of abdominal cancers who need this procedure, the options are limited to a handful of specialist centres worldwide. India is one of the most accessible.Gail found her way to HOSPIDIO. And then she found her way to Dr. Piyush Kumar Agarwal at Shalby International Hospital in Gurugram.
She had completed 12 cycles of chemotherapy at home. All that remained was the procedure that Barbados could not provide. India could.
Appendicular Cancer with Local Metastasis: Understanding the Diagnosis
Appendicular cancer refers to cancer originating in the appendix. While relatively rare, appendix cancers can spread to the peritoneum, the membrane lining the abdominal cavity and covering the abdominal organs, a pattern of spread known as peritoneal metastasis or local metastasis. When this occurs, the cancer is no longer confined to its site of origin and requires a treatment approach designed specifically for peritoneal disease.
Systemic chemotherapy, which travels through the bloodstream, has limited ability to reach cancer cells embedded in the peritoneal surface. This is why Gail had completed 12 cycles of systemic chemotherapy in Barbados, received the best care her local oncology team could offer, and still required a further procedure: the chemotherapy was doing what it could, but reaching peritoneal metastasis to the degree needed for surgical control required a different approach.That approach is HIPEC combined with cytoreductive surgery.
About peritoneal metastasis: Peritoneal metastasis occurs when cancer cells spread from a primary tumour and implant on the surface of the peritoneum. It is a distinct pattern of cancer spread that requires targeted treatment. HIPEC combined with cytoreductive surgery is currently the most effective treatment for selected patients with peritoneal metastasis from appendicular, colorectal, ovarian, and other abdominal cancers.
What Is HIPEC and Why Is It Only Available in Specialist Centres?
HIPEC, Hyperthermic Intraperitoneal Chemotherapy, is a surgical procedure performed in two stages. First, the surgeon removes all visible tumour deposits from the peritoneal surfaces and abdominal organs through cytoreductive surgery, a meticulous and often lengthy operation requiring a highly skilled oncological surgeon. Then, heated chemotherapy solution is circulated directly within the abdominal cavity for approximately 90 minutes, reaching cancer cells on the peritoneal surfaces in concentrations that systemic chemotherapy cannot achieve through the bloodstream.
The combination of heat and direct chemotherapy delivery to the peritoneal surface is what makes HIPEC effective for peritoneal disease. The hyperthermia, typically between 41 and 43 degrees Celsius, enhances the cytotoxic effect of the chemotherapy agents and improves their penetration into tumour tissue.
HIPEC combined with cytoreductive surgery is a major, complex procedure. It requires an experienced oncological surgeon with specific HIPEC training, a dedicated surgical team, a facility equipped for prolonged and complex open abdominal surgery, an intensive care unit for post-operative management, and the specialist nursing and medical infrastructure to manage recovery from what is one of the most demanding operations in abdominal oncology.It is not available in Barbados. It is not available in most of the Caribbean or across much of sub-Saharan Africa. The centres that perform it well are concentrated in Western Europe, North America, and a small number of specialist oncology centres in India and Asia.
Why HIPEC requires a specialist centre: The cytoreductive component of this procedure can take 6 to 12 hours and involves removing tumour deposits from multiple abdominal organs and surfaces. The surgeon must be specifically trained in peritoneal oncology surgery. Outcome data consistently shows that HIPEC results are significantly better at high-volume centres where the surgical team has extensive experience with this specific procedure.
How Gail Found HOSPIDIO and What Happened Next
When Gail's oncology team in Barbados confirmed she needed HIPEC and that it was not available on the island, she began researching her options. India had come up in her research as a destination with specialist HIPEC capability, and HOSPIDIO had come up as a patient facilitator with experience coordinating oncology journeys to India from the Caribbean.
She reached out to HOSPIDIO. The team reviewed her case, including her diagnosis, her chemotherapy history, and her current disease status, and sent her a structured set of recommendations identifying Dr. Piyush Kumar Agarwal at Shalby International Hospital, Gurugram, as the specialist best suited to her case.
The video consultation that changed everything
Before Gail committed to travelling, HOSPIDIO arranged a video consultation between her and Dr. Piyush Kumar Agarwal. This is one of the most important services HOSPIDIO provides for surgical oncology patients: the chance to meet the surgeon, ask questions, understand the proposed approach, and make an informed decision about whether to proceed, all before booking a flight.
For Gail, who had already been through 12 cycles of chemotherapy and was now facing a major surgical procedure far from home, that conversation mattered. She spoke directly with Dr. Agarwal. She heard his assessment of her case, his planned approach, and the realistic expectations for the procedure. She made her decision.
She booked her journey to India.
Pre-travel step: HOSPIDIO arranged a video consultation with Dr. Piyush Kumar Agarwal before Gail committed to travelling. She spoke directly with her surgeon, reviewed the plan, and arrived in India informed and prepared.
The Surgery: Cytoreductive Surgery and HIPEC at Shalby Hospital
Dr. Piyush Kumar Agarwal performed the combined cytoreductive surgery and HIPEC procedure at Shalby International Hospital in Gurugram. The surgery involved the meticulous removal of peritoneal tumour deposits, followed by the intraperitoneal chemotherapy perfusion phase under hyperthermia conditions.
The procedure was successful.HIPEC is a major operation, and recovery in the days and weeks that follow demands careful medical and nursing management. Gail remained in India to recover before returning to Barbados, allowing the Shalby team to monitor her recovery, manage any post-operative requirements, and ensure she was stable and comfortable enough for long-haul travel before her departure.
Surgical outcome: Cytoreductive surgery and HIPEC completed successfully by Dr. Piyush Kumar Agarwal. Recovery managed at Shalby Hospital. Gail returned to Barbados after a few weeks of recovery in India.
What HOSPIDIO Arranged Throughout Gail's Stay in India
From the first contact through to Gail's departure, HOSPIDIO coordinated every element of her journey.
- Case review and specialist matching: HOSPIDIO reviewed Gail's oncology reports, chemotherapy history, and current status before recommending Dr. Piyush Kumar Agarwal and Shalby Hospital as the right match for her specific procedure.
- Video consultation with Dr. Agarwal: HOSPIDIO arranged the pre-travel video consultation so Gail could meet her surgeon and discuss the procedure before committing to travel.
- Medical visa facilitation: HOSPIDIO managed the India Medical Visa application from Barbados, including the hospital invitation letter and all supporting documentation.
- Airport arrival and departure: a HOSPIDIO representative met Gail at Indira Gandhi International Airport on arrival and managed all transfers to her accommodation. Departure logistics were coordinated on completion of her recovery.
- Accommodation near Shalby Hospital: HOSPIDIO arranged suitable accommodation close to Shalby International Hospital for the duration of her stay, providing a comfortable and convenient base throughout her recovery period.
- Local transfers: all travel between accommodation and the hospital was managed by HOSPIDIO throughout her visit.
- Case coordination and support during recovery: HOSPIDIO's case management team remained in contact throughout her stay, supporting Gail through her post-operative recovery and keeping communication open between her, the surgical team, and her family in Barbados.
- Sightseeing during recovery: on days when Gail was well enough and wanted to step outside the hospital environment, HOSPIDIO arranged gentle local visits to help her feel engaged and supported through the recovery period rather than confined to accommodation.
- On pre-travel video consultations: HOSPIDIO arranges video consultations between patients and their proposed surgeons before travel for major surgical procedures as a standard part of the process.
For a procedure as significant as HIPEC, arriving in India having already spoken directly with your surgeon and understood the approach is not a convenience. It is a fundamental part of making an informed decision.
Going Home: A Departure Full of Emotion
When the time came for Gail to return to Barbados, she was emotional.Not from fear, or from relief alone, though there was surely relief. But from something harder to name and more meaningful: the feeling of having been genuinely cared for. Of having been in a foreign country, far from everyone she knew, facing one of the most serious medical procedures of her life, and having been met with warmth and dedication at every step.
She spoke about the love and support she had experienced in India. From Dr. Piyush Kumar Agarwal and the Shalby surgical team. From the HOSPIDIO coordinators who had been with her from the first conversation to the last transfer. She boarded her flight home having experienced something that patients often describe but that no marketing language can manufacture: the feeling of being genuinely looked after by people who cared about the outcome.
She did not just leave India treated. She left feeling loved. And she was emotional about it. That says everything about the kind of care that is possible when the right team surrounds you.
For Caribbean Patients Who Have Been Told They Need HIPEC
Gail's story carries a specific and urgent message for patients across Barbados, Trinidad, Jamaica, Guyana, and the wider Caribbean who have received a diagnosis of peritoneal metastasis from appendicular, colorectal, ovarian, or other abdominal cancers.
HIPEC combined with cytoreductive surgery is not available in the Caribbean. For patients who have been told they need this procedure, the pathway leads abroad. The most common routes are to the United States or the United Kingdom, both of which have HIPEC centres but at enormous cost and with the barriers of visa applications and limited access for patients without insurance coverage in those countries.
India offers the same procedure at specialist oncological centres, performed by surgeons trained specifically in peritoneal oncology surgery, at a fraction of the cost. Shalby Hospital in Gurugram is one of those centres. Dr. Piyush Kumar Agarwal has extensive experience with HIPEC and cytoreductive surgery for peritoneal metastasis from a range of abdominal primaries.
For Caribbean patients, the journey to India is not as short as flying to Miami. But HOSPIDIO's coordination makes it manageable. The visa process is supported end to end. The pre-travel video consultation means you meet your surgeon before you travel. The accommodation, transfers, recovery support, and ongoing case management are all in place before you land.
To understand how HOSPIDIO supports Caribbean patients through their medical journey to India: From WhatsApp to Discharge: How HOSPIDIO Manages Your Entire Medical Journey.
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Ashutosh heads the Patient Experience Department at HOSPIDIO, ensuring seamless, compassionate support for international patients seeking treatment in India. With deep expertise in medical travel and hospital coordination, he’s dedicated to making every patient feel safe and cared for. Outside work, he enjoys driving and exploring new cuisines.
Guneet Bhatia is the Founder of HOSPIDIO and an accomplished content reviewer with extensive experience in medical content development, instructional design, and blogging. Passionate about creating impactful content, she excels in ensuring accuracy and clarity in every piece. Guneet enjoys engaging in meaningful conversations with people from diverse ethnic and cultural backgrounds, enriching her perspective. When she's not working, she cherishes quality time with her family, enjoys good music, and loves brainstorming innovative ideas with her team.