HIPEC programme hailed as success

Two years ago the hospital started the UK’s first gynaeoncology hyperthermic intraperitoneal chemotherapy (HIPEC) programme and the only colorectal HIPEC programme in the East of England. It is used to treat advanced ovarian or bowel cancer, which has already spread to the abdominal cavity.

In that time the multidisciplinary team has completed 40 cases with good outcomes for the patients. This has been achieved by the efforts of a vast multi-disciplinary team.

HIPEC is a procedure carried out following the completion of complex surgery to remove all visible disease in the abdomen and pelvis.

After the initial procedure has been completed, a 40-42°C solution is washed through the patient, in an attempt to kill off any cells the surgeons have not been able to see.

Patients must meet very strict criteria to be eligible; their cancer must be advanced but not spread to other organs and they need to be assessed fit enough to undergo this extensive surgery.

Nikos Burbos, Consultant Gynaeoncologist Surgeon and Adam Stearns, Consultant Colorectal Surgeon, have led the collaboration and are encouraged by the results they have recorded.

“At the moment we are treating around 20 of our most advanced ovarian cancer patients a year,” said Nikos.

“These are people who have the most aggressive form of cancer, but who we feel benefit from this procedure. This is also a procedure which comes with a lot of risks and therefore needs a highly specialised team to be able to carry it out:

  • We are bringing dangerous chemotherapy drugs into our operating theatres which then have to be washed around the patient’s abdomen
  • We are heating up a solution to a very high temperature, but need to make sure that the overall body temperature doesn’t rise, which could be very dangerous
  • Body cooling blankets have to be applied throughout the procedure along with ice fluids washed through intravenously to stop the patient over-heating
  • Most importantly, HIPEC needs to be done by highly specialised surgeons, as removing all the visible cancer is the most important part of the procedure.

“We require highly specialised anaesthetists to be alongside the patient throughout. These are trailblazing anaesthetists who we have on board here.”

Our experience here means we are the only established centre in the UK to offer this service to ovarian cancer patients as part of the standard care. Recently, two other centres in England have started treating patients with ovarian cancer, The Christie in Manchester and the Royal Marsden in London.

The development of this service has been more than 10 years in the making and requires a huge level of collaboration across multiple teams including nurses, HCAs, pharmacy, oncologists, anaesthetists, intensive care team and various surgical specialties.

“We have been carrying out this procedure for nearly two years and we are extremely pleased with the outcomes we have seen. Research data from Europe suggest this procedure is extending patient lives by a year on top of their expected survival rates,” said Nikos

“This has been a very long time in development. First, we had to make sure we established a robust infrastructure for advanced ovarian cancer surgery before we could even entertain the idea of extending this to offering HIPEC.

“We would not have done this without having Adam Stearns with us. As our lead Consultant Colorectal Surgeon, his vision and drive to develop cancer services has allowed us to embark on this project – and we have been able to realise this project because of the huge efforts of all involved to learn about new procedures, understand the enormity of what we are trying to do and to visit other centres in Europe who are already well-established in this field. And then there is no easy way to learn this. It takes years of collaboration between colorectal, urologists, liver, and gastric surgeons, to develop this into a nationally accredited service.”

Adam said: “This has been an enormous team effort and we want to celebrate this achievement. This would not have been possible without the generous support of the Norfolk and Norwich Hospitals Charity and the Friends of NNUH, who gave £50,000, as well as donations from Norfolk businesses insurance specialists Alan Boswell, and charity supporter David Geiss.”

Julie Cooper, Head of Grants said: “The Norfolk and Norwich Hospitals Charity are delighted to have been able to fund the purchase of the HIPEC, thanks to money transferred from the Friends of the Hospital when they closed their charity.  This is yet another example of our local community donating to support improvements at our hospitals, over and above what the NHS must fund, and we are very grateful to everyone who has made this possible.”

The two surgeons invited key team members to a celebratory event in the Roy Snelling Lecture Theatre in the Bob Champion Research and Education Building, with Medical Director Professor Erika Denton opening, and CEO Sam Higginson closing the event.

Erika said: “This is an incredible example of extensive collaboration to provide better outcomes for our patients. This also means we can lead the way in developing these services for other trusts across the country.”

As he closed the event Sam said: “I have been so inspired by what I have heard here today. It makes me think this is the N&N at its best. Our approach was that we wanted to be the best for our patients and being innovative is the best way to achieve that – and what makes this even more impressive is that we did this throughout a global pandemic.”

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