Cytoreduction surgery followed by hyperthermic intraoperative peritoneal chemotherapy for peritoneal carcinomatosis

Summary

The Interventional Procedures Advisory Committee (IPAC) has considered this procedure and NICE has issued a consultation document about its safety and efficacy. Consultation has now ended. IPAC will consider the consultation comments and produce a Final Interventional Procedures Document, which will be considered by NICE before guidance is issued to the NHS in England, Wales, Scotland and Northern Ireland.

The consultation period for this procedure closed on the 23 November 2009.

If you wish to be updated to any developments with this procedure, you can express an interest here.

Description

Peritoneal metastases commonly result from the regional spread of gastrointestinal, gynaecological and other malignancies. Peritoneal carcinomatosis is an advanced form of cancer associated with short survival and poor quality of life, which may lead to bowel obstruction, ascites and pain.  

This procedure was developed by Paul Sugarbaker at the Washington Cancer Institute. A laparotomy is performed under general anaesthesia and all gross tumour is removed along with the involved organs, peritoneum and tissue. The surgery includes:

• removal of the right hemicolon, spleen, gall bladder, parts of the stomach, greater omentum and lesser omentum
• stripping of the peritoneum from the pelvis and diaphragm
• stripping of tumour from the surface of the liver
• removal of the uterus and ovaries in women
• removal of the rectum in some cases.

The aim of the surgery is to remove all macroscopic tumour, although residual tumour is sometimes left behind.

In the second stage of the procedure , the abdomen is perfused with fluid containing a chemotherapy agent, heated to between 40 and 48°C. The fluid is perfused for 60 to 120 minutes and then drained from the abdomen, before the laparotomy is closed. A further course of systemic or intraperitoneal chemotherapy may be administered after the surgery.   

Intraoperative intraperitoneal administration of chemotherapy allows the drug to be distributed uniformly to all surfaces of the abdomen and pelvis. Potential advantages of heating the perfusion fluid are that it increases drug penetration and the cytotoxic effect of drugs such as mitomycin C and cisplatin.

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Details

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Links:

	Cytoreduction surgery followed by hyperthermic intraoperative peritoneal chemotherapy for peritoneal carcinomatosis (interventional procedures consultation)	21 October 2009
	Cytoreduction surgery followed by hyperthermic intraoperative peritoneal chemotherapy for peritoneal carcinomatosis (interventional procedures overview)	20 October 2009
	IPG116 Complete cytoreduction and heated intraperitoneal intraoperative chemotherapy (Sugarbaker technique) for peritoneal carcinomatosis: guidance	23 March 2005
	IPG116 Complete cytoreduction and heated intraperitoneal intraoperative chemotherapy (Sugarbaker technique) for peritoneal carcinomatosis: understanding NICE guidance	23 March 2005
	IPG116 Cytoleihad cyflawn a chemotherapi mewnberitoneol mewnlawdriniaethol wedii gynhesu (techneg Sugarbaker)ar gyfer carsinomatosis peritoneol: deall canllawiau NICE	03 February 2009
	Interventional procedures consultation document - Complete cytoreduction and heated intraoperative intraperitoneal chemotherapy (Sugarbaker technique) for peritoneal carcinomatosis	23 November 2004
	Interventional procedures overview of complete cytoreduction and heated intraoperative intraperitoneal chemotherapy (Sugarbaker technique) in patients with peritoneal carcinomatosis	23 November 2004