The National Institute for Health and Care Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Ultra-radical (extensive) surgery for advanced ovarian cancer, in November, 2013.
Ovarian cancer is the leading cause of death from gynaecological cancer in the UK, and its incidence is rising. It is the fifth most common cancer in women, with a lifetime risk of about 2% for women in England and Wales.
Early symptoms of ovarian cancer are similar to those of other conditions and include persistent bloating, pain in the pelvis and lower abdomen, and urinary frequency and/or urgency. Most women who have ovarian cancer present with advanced disease and the outcome is generally poor, with an overall 5-year survival rate of less than 35%. The stage of the disease at diagnosis is the most important factor affecting outcome and is defined by the International Federation of Gynecology and Obstetrics (FIGO) system.
The main treatments for ovarian cancer are surgery and chemotherapy. Surgery usually involves bilateral salpingo-oophorectomy, total abdominal hysterectomy and omentectomy. Potentially curative surgery requires resection of all macroscopic disease. More commonly, the goal is to reduce the diameters of the remaining pieces of tumour tissue to less than 1 cm (optimal debulking). Advanced ovarian cancer is also sometimes treated by radiotherapy to shrink the tumour and reduce pain.
Radical procedures are generally not listed in OPCS-4 as these usually refer to a procedure on more than one site which may not be the same each time it is performed. There are no OPCS-4 codes which specifically classify radical (or ultra-radical [extensive]) surgery on the ovaries.
Within OPCS-4 these procedures would be coded by assigning codes to describe each of the different types of surgery performed or organs removed. Therefore hysterectomy, bilateral excision of ovary and fallopian tubes would be coded separately with additional codes assigned for any of the additional ultra-radical procedures such as extensive peritonectomy, resection of liver metastases etc.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.