The National Institute for Health and Care Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Irreversible electroporation for treating primary liver cancer in February 2013. NICE is currently updating this guidance. The new guidance will be published shortly. Until then the NHS should continue to follow the recommendations outlined in the current version of the guidance. The Interventional Procedures Advisory Committee (IPAC) will consider this procedure review and NICE will issue an interventional procedures consultation document about its safety and efficacy for 4 weeks’ public consultation. IPAC will then review the consultation document in the light of comments received and produce a final interventional procedures document, which will be considered by NICE before guidance is issued to the NHS in England, Wales, Scotland and Northern Ireland.
 
Status In progress
Process IP
ID number 1019
Description IRE for primary liver cancer is done with the patient under general anaesthesia. A neuromuscular blocking agent is used to prevent muscle spasms. Needle-like electrodes are introduced percutaneously into the tumour under imaging guidance (either CT or, less commonly, ultrasound). The distance between the electrodes is confirmed by imaging. This is to ensure that the electrodes are correctly placed parallel to each other and that enough current flow would be generated to ensure IRE. The procedure may also be done through an open surgical or laparoscopic approach, although the percutaneous route is the most common. In each ablation cycle, pulses of high-voltage direct current are delivered in groups (of about 10) with a brief time for recharging between groups (a cycle is usually completed in less than 2 minutes). Electrodes are repositioned under imaging guidance to extend the zone of electroporation until the entire tumour and an appropriate margin have been ablated. The number of ablations is determined by the volume of the target tumour. When the ablation procedure is completed, further imaging may be done to confirm the extent of the ablation.

Provisional Schedule

Expected publication 27 November 2019

Timeline

Key events during the development of the guidance:

Date Update
19 June 2019 - 17 July 2019 Interventional procedure consultation

For further information on how we develop guidance, please see our page about NICE interventional procedures guidance