The National Institute for Health and Care Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Cytoreduction surgery followed by hyperthermic intraoperative peritoneal chemotherapy for peritoneal carcinomatosis in July 2009. 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 256
Description Cytoreduction surgery is done to remove all macroscopic tumours within the peritoneal cavity. Hyperthermic intraoperative peritoneal chemotherapy is then used to distribute a chemotherapeutic drug uniformly to all surfaces of the intra-abdominal cavity and to increase drug penetration. This is done to treat any remaining microscopic traces of the cancer. The aim is to reduce symptoms, extend survival and improve quality of life. Using general anaesthesia, a laparotomy is done and all macroscopic tumour is removed, with resection of involved organs and stripping of the tumour from the surface of some organs and peritoneum. The surgery, which is extensive and complex is followed by perfusion of the abdominal cavity for 30 to 120 minutes with a heated (between 40 and 48°C) chemotherapy solution (such as Mitomycin C or cisplatin). The fluid is then drained from the abdominal cavity before it is closed. This part of the procedure is generally called HIPEC (hyperthermic intraperitoneal chemotherapy), but in the past has been known as HIIC (heated intraoperative intraperitoneal chemotherapy), IPCH (intraperitoneal chemotherapy) and IPHC (intraperitoneal hyperthermic chemotherapy). A further course of systemic or early postoperative intraperitoneal chemotherapy (EPIC) may be administered for 4 to 5 days following the procedure. The surgery is extensive and may include: • removal of the right hemicolon, spleen, gall bladder, parts of the stomach, greater omentum and lesser omentum • stripping of the peritoneum from the pelvis and diaphragm • stripping of tumour from the surface of the liver • removal of the uterus and ovaries in women • removal of the rectum in some cases.

Provisional Schedule

Expected publication 03 March 2021

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Timeline

Key events during the development of the guidance:

Date Update
27 August 2020 - 25 September 2020 Interventional procedure consultation

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