840 Establishment of a standard operating procedure for management of patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for epithelial ovarian cancer: an Irish experience

Introduction/Background Increasing evidence shows improved overall survival when Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is performed during interval cytoreductive surgery (CRS) for epithelial ovarian cancer. Despite this, many centres have been hesitant to implement HIPEC programs due to challenges, such as increased morbidity, costs, resource requirements and safety concerns. These challenges can be overcome but should include the establishment of robust Standard Operating Procedures (SOP's). This process can promote institutional support, identify a dedicated multidisciplinary team, ensure appropriate training, and audit. This review describes the key elements of a SOP for CRS & HIPEC in Ovarian Cancer. Methodology The Peritoneal Malignancy Institute in the Mater Hospital was established in 2013 and the Ovarian Cancer program in 2017. For the establishment of the SOP, key stakeholders were consulted, and a group identified for SOP development. Guidance was established via standard methodology with systematic review performed. External support and review from Peritoneal Malignancy Institute, Basingstoke, UK. SOP was divided into the following key sections: - Introduction & Evidence - Pre-operative evaluation of patients with peritoneal malignancy - Peri-operative care of patients undergoing cytoreductive surgery and HIPEC - Guidelines for the management of intra-peritoneal chemotherapy Results Clear and detailed guidance was established and distributed to all staff involved. Strict inclusion and exclusion criteria was established. Peri-operative management guidelines set including mechanical bowel preparation and carbohydrate drinks. Intraoperative use of sodium thiosulphate implemented along with standardising of operative notes. Chemotherapy preparation, delivery, and disposal protocols were designed. To date over 70 cases of ovarian cancer CRS with HIPEC have been performed with no increase in morbidity or mortality. No serious adverse incidents involving patients or healthcare personnel have been reported. Conclusion HIPEC may be an important part of the armoury in treating ovarian cancer in selected patients. Clear and robust SOP's are a critical component of the safe establishment of this potentially hazardous procedure. Disclosures None.