title: Mentored experience of establishing a national peritoneal malignancy programme - Experience of first 50 operative cases.
abstract: BACKGROUND
  Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) are considered standard of care for pseudomyxoma peritonei (PMP) and selected patients with colorectal peritoneal metastases (CPM) or peritoneal mesothelioma. A National Peritoneal Malignancy programme was established in Ireland (population of 4.5 million) in May 2013 with mentoring and support from the Peritoneal Malignancy Institute, Basingstoke UK. This study reviews the operative and oncological outcomes for the first 50 patients who underwent CRS and HIPEC in Ireland.
  
  
  METHODS
  This is a retrospective review of all patients referred, and of the subset who underwent CRS and HIPEC, for peritoneal malignancy in Ireland between May 2013 and November 2015.
  
  
  RESULTS
  During the study period, 130 patients were referred and 50 patients were selected for CRS and HIPEC. Three patients were found to have unresectable disease at laparotomy. Of the remaining 47 patients, eight had major tumour debulking. In total, 39 underwent complete cytoreduction and 45 received HIPEC. After a median follow-up of 12.7 months, 12 patients had developed further metastatic disease. The rates of complete cytoreduction, major complication (Clavien-Dindo III/IV) and operative mortality were 83%, 0% and 0%, respectively. 32% of patients experienced grade I/II complications.
  
  
  CONCLUSIONS
  We report the successful establishment of a national peritoneal malignancy programme. Mentoring from an experienced centre may have shortened the known learning curve evident by our encouraging outcomes. The follow-up period is short, however our early results are comparable with internationally reported figures.
authors.affiliation: National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin, Ireland. Electronic address: kahhoong_chang@yahoo.co.uk.
authors.forename: K H
authors.initials: KH
authors.lastname: Chang
authors.affiliation: National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin, Ireland. Electronic address: mikazanowski@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Kazanowski
authors.affiliation: National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin, Ireland. Electronic address: ostaunton@mater.ie.
authors.forename: O
authors.initials: O
authors.lastname: Staunton
authors.affiliation: National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin, Ireland. Electronic address: rcahill@mater.ie.
authors.forename: R A
authors.initials: RA
authors.lastname: Cahill
authors.affiliation: Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, United Kingdom. Electronic address: brendan.moran@hhft.nhs.uk.
authors.forename: B J
authors.initials: BJ
authors.lastname: Moran
authors.affiliation: National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin, Ireland. Electronic address: cshields@mater.ie.
authors.forename: C
authors.initials: C
authors.lastname: Shields
authors.affiliation: National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin, Ireland. Electronic address: jmulsow@mater.ie.
authors.forename: J
authors.initials: J
authors.lastname: Mulsow
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood; D065426:Cytoreduction Surgical Procedures; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008654:Mesothelioma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D011553:Pseudomyxoma Peritonei / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor
keywords: Cytoreductive surgery; Hyperthermic intraperitoneal chemotherapy; Outcomes; Peritoneal malignancy; Peritoneal metastasis; Pseudomyxoma peritonei