title: Cytoreductive surgery with a hyperthermic intraperitoneal chemotherapy program: Safe after 40 cases, but only controlled after 140 cases.
abstract: BACKGROUND
  Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), used to treat peritoneal surface malignancies (PSM), is a complex procedure with significant major morbidity (MM).
  
  
  OBJECTIVE
  To investigate the learning curve (LC) of CRS with HIPEC in a new specialized surgical unit with a fully trained senior surgeon and individualize the variables associated with morbidity and oncological results.
  
  
  METHODS
  A total of 290 consecutive patients with PSM were included. Complete CRS with HIPEC was performed in 204 patients. A risk-adjusted sequential probability ratio test was used to assess the LC on the basis of rates of incomplete cytoreduction (IC) and MM.
  
  
  RESULTS
  Complete CRS, MM, and mortality rates were 70.4%, 30.4%, and 2.5%, respectively. Tumor histotype, a high peritoneal cancer index (PCI) and the invaded region were the major independent risk factors for IC, whereas previous surgery, high PCI, stomia realization and blood transfusion were predictors of MM. RA-SPRT showed that 140 and 40 cases were needed to achieve the lowest risk of IC and MM, respectively.
  
  
  CONCLUSIONS
  CRS with HIPEC to treat PSM has a steep LC. Drastic selection has to be made at the beginning, excluding high PCI, rare peritoneal disease and patients previously operated on.
authors.affiliation: Surgical Oncologic & Digestive Unit, Hôpital Lariboisière-AP-HP, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France; Université Paris Diderot, Sorbonne Paris Cité, CART, INSERM U965, F-74575 Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Voron
authors.affiliation: Surgical Oncologic & Digestive Unit, Hôpital Lariboisière-AP-HP, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France; Université Paris Diderot, Sorbonne Paris Cité, CART, INSERM U965, F-74575 Paris, France. Electronic address: clarisse.eveno@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Eveno
authors.affiliation: Surgical Oncologic & Digestive Unit, Hôpital Lariboisière-AP-HP, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France; Université Paris Diderot, Sorbonne Paris Cité, CART, INSERM U965, F-74575 Paris, France.
authors.forename: I
authors.initials: I
authors.lastname: Jouvin
authors.affiliation: Surgical Oncologic & Digestive Unit, Hôpital Lariboisière-AP-HP, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France; Université Paris Diderot, Sorbonne Paris Cité, CART, INSERM U965, F-74575 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Beaugerie
authors.affiliation: Surgical Oncologic & Digestive Unit, Hôpital Lariboisière-AP-HP, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France; Université Paris Diderot, Sorbonne Paris Cité, CART, INSERM U965, F-74575 Paris, France.
authors.forename: R
authors.initials: R
authors.lastname: Lo Dico
authors.affiliation: Université Paris Diderot, Sorbonne Paris Cité, CART, INSERM U965, F-74575 Paris, France; Department of Anesthesiology, Hôpital Lariboisière-AP-HP, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France.
authors.forename: S
authors.initials: S
authors.lastname: Dagois
authors.affiliation: Université Paris Diderot, Sorbonne Paris Cité, CART, INSERM U965, F-74575 Paris, France; Department of Abdominal Imaging, Hôpital Lariboisière-AP-HP, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France.
authors.forename: P
authors.initials: P
authors.lastname: Soyer
authors.affiliation: Surgical Oncologic & Digestive Unit, Hôpital Lariboisière-AP-HP, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France; Université Paris Diderot, Sorbonne Paris Cité, CART, INSERM U965, F-74575 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Pocard
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D007274:Injections, Intraperitoneal; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
chemical_list: D000970:Antineoplastic Agents
keywords: Cytoreductive surgery; Hyperthermic intraperitoneal chemotherapy; Learning curve; Peritoneal surface malignancies