This guidance replaces previous guidance on complete cytoreduction and heated intraoperative intraperitoneal chemotherapy (Sugarbaker technique) for peritoneal carcinomatosis (interventional procedure guidance 116).
1.1 Current evidence on the efficacy of cytoreduction surgery (CRS) followed by hyperthermic intraoperative peritoneal chemotherapy (HIPEC) for peritoneal carcinomatosis shows some improvement in survival for selected patients with colorectal metastases, but evidence is limited for other types of cancer. The evidence on safety shows significant risks of morbidity and mortality which need to be balanced against the perceived benefit for each patient. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.
1.2 Clinicians wishing to undertake CRS followed by HIPEC for peritoneal carcinomatosis should take the following actions.
Inform the clinical governance leads in their Trusts.
Ensure that patients and their carers understand the uncertainty about the procedure's safety and efficacy in relation to the potential morbidity and mortality and the prolonged recovery period, and provide them with clear written information. In addition, the use of NICE's information for patients ('Understanding NICE guidance') is recommended.
Audit and review clinical outcomes of all patients having CRS followed by HIPEC for peritoneal carcinomatosis (see section 3.1).
1.3 Patient selection and treatment should be carried out in the context of a multidisciplinary team, including oncologists and surgeons with experience in this operation.
1.4 NICE encourages further research into this procedure which should take the form of randomised controlled trials (RCTs) with clear descriptions of patient selection criteria and the types of cancer being treated. The chemotherapy regimens used should be well defined. Outcome measures should include survival and quality of life.