Evidence on the safety of cytoreduction surgery with hyperthermic intraoperative peritoneal chemotherapy for peritoneal carcinomatosis shows frequent and serious but well-recognised complications. Evidence on its efficacy is limited in quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE website.
Clinicians wishing to do cytoreduction surgery with hyperthermic intraoperative peritoneal chemotherapy for peritoneal carcinomatosis should:
Inform the clinical governance leads in their healthcare organisation.
Give patients (and their families and carers as appropriate) clear written information to support shared decision making, including NICE's information for the public.
Ensure that patients (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these.
Audit and review clinical outcomes of all patients having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedures outcomes audit tool (for use at local discretion).
Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.
Healthcare organisations should:
Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for every patient having this procedure.
Regularly review data on outcomes and safety for this procedure.
Patient selection should be done by an experienced multidisciplinary team.
The procedure should only be done in highly specialised centres by clinicians with specialist expertise and specific training in cytoreduction surgery and hyperthermic intraoperative peritoneal chemotherapy.
NICE encourages further research in the form of randomised controlled trials. 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.
NICE may update the guidance on publication of further evidence.