Maximal effort cytoreductive surgery for advanced ovarian cancer
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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 13 sources, which was discussed by the committee. The evidence included 2 systematic reviews, 9 cohort studies, 1 non-randomised comparative study and 1 case series. 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: overall survival, progression free survival, residual tumour after surgery and quality of life after surgery.
3.3 The professional experts and the committee considered the key safety outcomes to be: perioperative death, organ failure, thromboembolism, wound complications and unanticipated need for stoma.
3.4 Fourteen commentaries from people who have had this procedure were discussed by the committee.
Committee comments
3.5 The committee noted that in the published literature different terms have been used to describe this procedure, such as ultra-radical, extensive and maximal effort cytoreductive surgery.
3.6 The procedure involves extensive surgery with a risk of significant complications including death.
3.7 There needs to be detailed preoperative assessment of the person's fitness to have maximal effort cytoreductive surgery and postoperative arrangements should include the availability of intensive care.
3.8 The extent of disease may not be apparent until surgery has started and it may be that maximal effort cytoreductive surgery is not possible.
3.9 The committee noted that the surgical techniques used in this procedure have evolved since the last NICE interventional procedures guidance on this procedure was issued.
3.10 There have been developments in chemotherapy and other systemic treatments for ovarian cancer since the last NICE interventional procedures guidance on this procedure was issued.
3.11 The committee encourages centres doing this procedure to submit data to an appropriate register.
3.12 The committee was pleased to receive patient commentary and to have a representative from a patient organisation at the meeting.
Tom Clutton-Brock
Chair, interventional procedures advisory committee
October 2022
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