Learning Curve for Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Peritoneal Surface Malignancy—A Journey to Becoming a Nationally Funded Peritonectomy Center

Abstract

The study suggests that there is a learning curve associated with this procedure. With accumulated experience in this procedure, an acceptable morbidity rate can be achieved.

Complications of Cytoreductive Surgery and HIPEC in the Treatment of Peritoneal Metastases

“…Over the years, reduction of post-operative mortality has been reported from tertiary centres worldwide. Moran reported a decreased mortality rate from 18 % down to 3 % [11,30], The Netherlands Cancer Institute reported a decrease in mortality from 8 % to 4 % [9], and Yan et al reported a decrease from 7 % to 1 % [10], all of which point towards the strong influence of the learning curve.…”

“…Several factors have been analyzed as predictive factors of moderate to severe morbidity following CRS and HIPEC such as sex [35], age, primary colonic anastomosis, number of peritonectomy procedures [10,14,15,28,42], number of visceral resections [10,14,28], number of anastomosis [10], incomplete cytoreduction, disruption of the umbilical fissure [43], dose of chemotherapeutic agent [15], intra-abdominal HIPEC temperature and histopathologic grade [42].…”

“…The authors [9,10] concluded that the improvement in the perioperative outcome of patients over time was the result of improved surgical techniques, increased experience and other intuitive factors that are difficult to quantify. Over the years, reduction of post-operative mortality has been reported from tertiary centres worldwide.…”

“…In a systematic review of literature, Chua et al reported that morbidity and mortality associated with CRS and HIPEC performed in specialized centers were not significantly superior compared to morbidity and mortality of other major gastrointestinal interventions [2]. Several authors have reported reduction of morbidity and mortality over time, stressing the importance of the Blearning curve^principle [9][10][11]. In this article, we review the complications that can occur after CRS and HIPEC and the risk factors associated with increased incidence of morbidity and mortality.…”

Toward curative treatment of peritoneal carcinomatosis from nonovarian origin by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy

“…Moran reported a decreased mortality rate from 18% down to 3%, 21 The Netherlands Cancer Institute reported a decrease in mortality from 8% to 4%, 22 and Yan et al reported a decrease from 7% to 1%. 23 All interventional complex procedures have an inherent risk, and experience undoubtedly diminishes but can never abolish this risk. 24 The morbidity and mortality rates of 33.6% and 4.1%, respectively, are similar to those reported after other major surgical procedures, such as esophagectomy or pancreaticoduodenectomy, With the potential survival benefit demonstrated after cytoreductive surgery for PC, these rates are acceptable.…”