Norfolk and Norwich University Hospitals (NNUH) are marking the successful establishment of the UK’s only gynae-oncology programme administering heated chemotherapy at the time of surgery for patients with ovarian cancer.

Since establishing the service two years ago, a multidisciplinary team has completed 40 cases, recording good outcomes for their patients. This has been achieved by the efforts of a vast multi-disciplinary team including consultants, senior ward staff, nurses, health care assistants, pharmacists, occupational therapists and admins and clerical staff across our surgical and medical division.

Heated intraperitoneal chemotherapy (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 remaining cells.

Patients have to meet very strict criteria to be eligible; their cancer must be advanced but not spread to other organs unless it is a different type of cancer and not linked to the first. They must also be assessed fit enough to undergo the gruelling major surgery.

NNUH Consultant Gynaeoncology Surgeon, Nikos Burbos, has led on this programme with collaboration from NNUH Consultant Colorectal Surgeon, Adam Stearns, who already provides this service for colorectal cancer patients.

Mr Burbos said: “At the moment we are treating 20-30 of our most advanced ovarian cancer patients a year. 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.”

The risks involved in the procedure include the presence of dangerous chemotherapy drugs within operating theatres, which must be heated up and washed around the patient’s abdomen. To ensure the patient’s body temperature doesn’t rise to harmful levels, body cooling blankets must be applied throughout the procedure, along with ice fluids washed through the patient intravenously.

Additionally, HIPEC procedures must be conducted by highly specialised surgeons to ensure that all visible cancer is removed during the process.

“Research data from Europe suggest this procedure is extending patient lives by a year on top of their expected survival rates.”

Nikos Burbos, Consultant Gynaeoncology Surgeon, Norfolk and Norwich University Hospitals

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

The experience at NNUH means the Trust is 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.

Mr Burbos said: “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.

“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.”

He added: “We would not have done this without having Adam Stearns here at NNUH. 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 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, pancreatic, gastro, urologists alongside gynaecology to develop this into an established service.”

Mr Stearns said: “This has been an enormous team effort with everyone involved invested in developing a service which is demonstrating real benefits to our patients. It could 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.”

Norfolk and Norwich Hospitals Charity’s Head of Grants, Julie Cooper, 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.”

NNUH Medical Director Professor Erika Denton 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.”

NNUH Chief Executive Sam Higginson said: “This is NNUH 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.”