Draft guidance from the National Institute for Health and Care Excellence (NICE) advises that cytoreduction surgery with hyperthermic intraoperative peritoneal chemotherapy (HIPEC) should only be used for peritoneal carcinomatosis with special arrangements for clinical governance, consent, and audit or research.
The guidance states that evidence on the safety of the procedure shows frequent and serious but well-recognised complications. Evidence on its efficacy is limited in quality.
Clinicians wishing to carry out the procedure should:
- Inform the clinical governance leads in their NHS trusts.
- Give patients and their carers clear written information to support shared decision-making, including NICE's information for the public.
- Ensure patients understand the risk of complications and death, the need for intensive care after the procedure, the long recovery period, and the uncertainty about the procedure's efficacy.
- Audit and review clinical outcomes of all patients having the procedure. NICE is developing an audit tool which will be available when the guidance is published.
The procedure should only be done in highly specialised centres by clinicians with specialist expertise and specific training in cytoreduction surgery and HIPEC.
NICE is encouraging further research on the treatment in the form of randomised controlled trials and says these should clearly describe the patient selection criteria, the types of cancer being treated, and the chemotherapy regimens used. Outcomes should include survival, reduction in tumour burden, and quality of life.
The draft guidance is open for public comment until 25 September 2020. The final version is expected to be published in February 2021.
This article originally appeared on Univadis, part of the Medscape Professional Network.
