3 Committee considerations

3 Committee considerations

The evidence

3.1 NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 10 sources, which was discussed by the committee. The evidence included 6 meta-analyses, 3 systematic reviews and 1 randomised controlled trial. It is presented in the summary of key evidence section in the interventional procedures overview. Other relevant literature is in the appendix of the overview.

3.2 The professional experts and the committee considered the key efficacy outcomes to be: progression-free survival, disease-free survival, recurrence-free survival, overall survival and improvement in quality of life (physical and emotional).

3.3 The professional experts and the committee considered the key safety outcomes to be: postoperative haemorrhage, perioperative mortality, anastomotic leaks, sepsis, pain, stoma rate, readmission to an intensive care unit and the need for further surgery.

3.4 Two commentaries from patients who have had this procedure were discussed by the committee.

Committee comments

3.5 This procedure is unlikely to be curative and may be offered to patients for whom cure is not the intention. Therefore, it is important that patients are clearly informed that the procedure is associated with significant periprocedural morbidity including prolonged treatment in an intensive care unit and long-term postoperative recovery.

3.6 The resectability of the tumours is important in determining the outcome, but criteria for this have not been clearly established.

3.7 Hyperthermic intraoperative peritoneal chemotherapy has no standardised protocol, and protocols are continuing to evolve. Variations in the drug regimens include temperature, dose, duration of infusion time, and whether a drug is used on its own or in combination with other drugs.

3.8 There have been large improvements in survival and quality of life for patients with metastatic cancer in recent years because of advances in systemic chemotherapy. This made it difficult to assess the benefits of hyperthermic intraoperative peritoneal chemotherapy.

3.9 The outcomes are different depending on the type of tumour being treated.

ISBN: 978-1-4731-4025-7

  • National Institute for Health and Care Excellence (NICE)