The National Institute for Health and Care Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Chemosaturation via percutaneous hepatic artery perfusion and hepatic vein isolation for primary or metastatic liver cancer in May 2014. 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 1062
Description The aim of melphalan chemosaturation with percutaneous hepatic artery perfusion and hepatic vein isolation is to treat liver cancer by delivering a high dose of melphalan chemotherapy directly into the hepatic artery. As the blood leaves the liver, it is diverted out of the body through a catheter and filtered to reduce the level of melphalan before being returned to the circulation. This allows high doses of melphalan chemotherapy to be used, which would otherwise not be tolerated because of severe systemic side effects. The procedure is usually done under general anaesthesia. An infusion catheter is inserted into the femoral artery and guided into the hepatic artery. The femoral vein is then cannulated and a special multi-lumen, double-balloon catheter is inserted into the inferior vena cava and across the hepatic veins. The balloons are inflated and positioned in such a way that all the blood leaving the liver (via the hepatic veins) enters this catheter, rather than the systemic circulation. High doses of melphalan are then infused directly into the liver via the hepatic artery infusion catheter over about 30 minutes. During this time, blood leaving the liver passes through an extracorporeal filtration system that removes most of the melphalan drug before the blood is returned to the circulation via a catheter in the internal jugular vein. Full anticoagulation with heparin is needed throughout the procedure. The procedure causes significant changes in the patient’s haemodynamic status, and this must be managed by the anaesthetic team with support from a clinical perfusion scientist. To reduce the risk of the chemotherapy reaching other organs, some specialists advocate that an angiogram is done first to check the arterial circulation and any branches near the liver supplying other structures, such as the stomach, are embolised to prevent the chemotherapy reaching these organs and causing damage.

Provisional Schedule

Interventional procedure consultation 25 June 2020 - 23 July 2020
Expected publication 16 December 2020

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