Learning curve for cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis.
BACKGROUND
Combined cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC) has been considered as a standard approach for peritoneal surface malignancy. This study aims to assess the learning curve of this combined approach.


METHODS
Prospectively collected data of our first 800 consecutive patients treated by CRS and PIC between January 1996 and July 2014 were retrospectively reviewed. Eight hundred patients were divided into two groups and eight groups for comparison. A significant difference was defined as P < 0.05.


RESULTS
A significant increase in the rate of the completeness of cytoreduction (CC) score-0 from 74.0% to 83.0% was seen with a reduction in rates of other CC scores. Also, there was a decreasing trend in mean blood transfusion units. The rate of viscus perforation, fistula formation and small bowel obstruction was significantly lower in the recent 400 patients. However, there was a significant increase in the incidence of deep venous thrombosis and pulmonary embolism. There was an improvement in the 5-year survival rate for patients with colorectal cancer, pseudomyxoma peritonei and mesothelioma.


CONCLUSIONS
Our findings demonstrate a learning curve associated with the combined approach of CRS and PIC. With adequate experience, CRS and PIC can be safely performed with acceptable mortality and morbidity.
St George Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
Yeqian
Y
Huang
Department of Surgery, St George Hospital, Sydney, New South Wales, Australia.|College of Medicine, Imam Muhammad ibn Saud Islamic University, Riyadh, Saudi Arabia.
Nayef A
NA
Alzahrani
Department of Medical Oncology, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia.
Winston
W
Liauw
Department of Surgery, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia.
David L
DL
Morris
D010478:Chemotherapy, Cancer, Regional Perfusion / Q000193:education*; D065426:Cytoreduction Surgical Procedures / Q000193:education*; D005260:Female; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D019990:Perioperative Care / Q000379:methods*; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
cytoreductive surgery; learning curve; peritoneal carcinomatosis