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.


The most common types of primary liver cancer are hepatocellular carcinoma (also known as hepatoma) and cholangiocarcinoma. However, cancer occurs more often as a result of metastases from other sites such as the lung, colon, stomach and eye (particularly ocular melanoma).

Treatment for primary or metastatic liver cancer depends on the location and stage of the cancer and how well liver function is preserved. Treatment options include surgical resection, thermal ablation, systemic chemotherapy, transarterial chemoembolisation and selective internal radiation therapy. Liver transplantation may be appropriate for some patients. In patients with primary liver cancer, surgical removal with curative intent may be possible. For most patients with liver metastases, treatment with curative intent is not possible.

Regional hepatic arterial delivery of high-dose chemotherapy with isolated hepatic perfusion used to be done using open surgical techniques, which carried a risk of significant morbidity and mortality. It is now done percutaneously: this means that the procedure is less invasive and it can also be repeated.

Coding recommendations

J10.3 Percutaneous transluminal injection of therapeutic substance into liver

Y53.2 Approach to organ under ultrasonic control

Z37.6 Hepatic artery

X70-X71 Procurement of drugs for chemotherapy for neoplasm Bands 1–10 (depending on the cytotoxic drug used)

X72 Delivery of chemotherapy for neoplasm (the delivery code is for outpatients and day cases only)

X33.8 Other specified other blood transfusion

In addition an ICD-10 code from category C22 Malignant neoplasm of liver and intrahepatic bile ducts, or code C78.7 Secondary malignant neoplasm of liver and intrahepatic bile duct would be recorded.

Your responsibility

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, and specifically any special arrangements relating to the introduction of new interventional procedures. 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. 

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

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. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.

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.

  • National Institute for Health and Care Excellence (NICE)