Gastrointestinal Oncology

Annals of Surgical Oncology

, Volume 14, Issue 8, pp 2270-2280

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

  • Tristan D. YanAffiliated withNationally Funded Peritonectomy Center, Department of Surgery, University of New South Wales
  • , Matthew LinksAffiliated withDepartment of Medical Oncology, St George Hospital
  • , Sal FransiAffiliated withDepartment of Anesthesiology, St George Hospital
  • , Theresa JacquesAffiliated withIntensive Care Unit, St George Hospital
  • , Deborah BlackAffiliated withSchool of Public Health and Community Medicine, University of New South Wales
  • , Vanessa SaundersAffiliated withNationally Funded Peritonectomy Center, Department of Surgery, University of New South Wales
  • , David L. MorrisAffiliated withNationally Funded Peritonectomy Center, Department of Surgery, University of New South Wales Email author 

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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 ≤ 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.

Keywords

Cytoreductive surgery Intraperitoneal chemotherapy Colorectal peritoneal carcinomatosis Pseudomyxoma peritonei Peritoneal surface malignancy Peritoneal mesothelioma Learning curve Morbidity and mortality