title: Learning curve for cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal surface malignancy--a journey to becoming a Nationally Funded Peritonectomy Center.
abstract: BACKGROUND
  Cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) for peritoneal surface malignancy is associated with a morbidity rate of 30-50% and a mortality rate of 1-10%. Recently, the St George Hospital in Sydney has been commissioned as the Nationally Funded Center for treatment of peritoneal surface malignancy in Australia.
  
  
  METHODS
  The clinical and treatment-related data regarding 140 consecutive patients were prospectively collected. A comparison between the initial 70 patients (Group I) and the subsequent 70 patients (Group II) was performed. Univariate and multivariate analyses were conducted to identify the significant risk factors for moderate to severe morbidity.
  
  
  RESULTS
  The hospital mortality was 4%. Sixty-one patients (44%) had moderate morbidity. Twenty-eight patients (20%) experienced severe morbidity. The mean hospital stay was 30 days. Twenty-seven patients (19%) were readmitted after initial discharge for management of delayed complications. The severe morbidity rate reduced from 30% to 10%, and the delayed morbidity rate reduced from 29% to 10%, when comparing Groups I and II. There were also reduced transfusion requirement, duration of operation, and intensive care unit stay. In the multivariate analysis, Group I (vs Group II; P = .005), performing small bowel resection (P = .005), and >4 peritonectomy procedures (vs <or= 4; P = .013) were the three independent risk factors for severe complications.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Nationally Funded Peritonectomy Center, Department of Surgery, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Tristan D
authors.initials: TD
authors.lastname: Yan
authors.forename: Matthew
authors.initials: M
authors.lastname: Links
authors.forename: Sal
authors.initials: S
authors.lastname: Fransi
authors.forename: Theresa
authors.initials: T
authors.lastname: Jacques
authors.forename: Deborah
authors.initials: D
authors.lastname: Black
authors.forename: Vanessa
authors.initials: V
authors.lastname: Saunders
authors.forename: David L
authors.initials: DL
authors.lastname: Morris
mesh_terms: D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage; D001315:Australia / Q000453:epidemiology; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D013502:General Surgery / Q000193:education*; D006801:Humans; D007263:Infusions, Parenteral; D007430:Intraoperative Care; D007858:Learning; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009026:Mortality; D017239:Paclitaxel / Q000008:administration & dosage; D010533:Peritoneal Lavage; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000453:epidemiology* / Q000601:surgery; D010537:Peritoneum / Q000601:surgery*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D000972:Antineoplastic Agents, Phytogenic; D017239:Paclitaxel; D005472:Fluorouracil