1.1 Current evidence on the safety and efficacy of ultra-radical (extensive) surgery for advanced ovarian cancer is inadequate. Therefore this procedure should not be done except with special arrangements for clinical governance, consent and audit or research (with the objective of publishing outcomes for all patients having this procedure – see recommendation 1.5).
1.2 Clinicians wishing to undertake ultra-radical surgery for advanced ovarian cancer should take the following actions:
Inform the clinical governance leads in their NHS trusts.
During the consent process, inform patients clearly about alternative treatment options, and about their benefits and risks compared with ultra-radical surgery for advanced ovarian cancer. Clinicians should provide patients with clear written information. In addition, the use of NICE's information for the public is recommended.
Clinicians should submit data on all patients having this procedure to the national register when it becomes available and review clinical outcomes locally.
1.3 Selection of patients should be done by a specialist gynaecological cancer multidisciplinary team.
1.4 Ultra-radical surgery for advanced ovarian cancer should be done by collaboration between surgeons with appropriate expertise (such as specialists in gastrointestinal and hepatobiliary surgery) and/or by specialists in gynaecological cancer surgery with specific training in such extensive surgery. The procedure should only be done in specialised units with a regular practice in this type of surgery.
1.5 NICE encourages further research on this procedure, either in the form of research trials or in audits intended for publication (ideally by collaboration between units). Clinicians should ensure that details of patient selection and the precise extent of surgery are fully documented. Reported outcomes should include all complications, survival, and quality of life. Trials comparing complication rates, survival and quality of life against those of standard surgery and chemotherapy would be especially useful.