Cytoreduction surgery followed by hyperthermic intraoperative peritoneal chemotherapy for peritoneal carcinomatosis
Summary
The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Cytoreduction surgery followed by hyperthermic intraoperative peritoneal chemotherapy for peritoneal carcinomatosis.
It replaces the previous guidance on Cytoreduction surgery followed by hyperthermic intraoperative peritoneal chemotherapy for peritoneal carcinomatosis (Interventional Procedures Guidance no. 116, November 2004).
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.
NICE Pathways
This guidance has been incorporated into the following NICE Pathways, along with other related guidance and products.
Visit the NICE Pathway: colorectal cancer
OPCS4.6 Code(s):
This procedure cannot be expressed in the OPCS-4 classification by a single code. The current guidance would be to code each organ removed as per normal coding rules, and to combine this with the ICD-10 diagnosis codes for category C48.- Malignant neoplasm of retroperitoneum and peritoneum or C78.6 Secondary malignant neoplasm of retroperitoneum and peritoneum.
Heated chemotherapy cannot currently be specifically captured using OPCS-4. At present this is captured using the following codes:
T48.2 Introduction of cytotoxic substance into peritoneal cavity plus a code from categories X70-X71 Procurement of drugs for chemotherapy for neoplasm in Bands 1-10 dependent on the regimen prescribed.
The NHS Classifications Service of NHS Connecting for Health is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS. The NHS Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided. www.connectingforhealth.co.uk/clinicalcoding
Details
Digestive system
Contact details:
(for procedure specific enquiries or comments)
ip@nice.org.uk
Interventional Procedures Programme
National Institute for Health and Clinical Excellence
MidCity Place
71 High Holborn
London
WC1V 6NA
Links:
This page was last updated: 10 November 2011
