This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Yan, T. D. Articles by Morris, D. L. Search for Related Content PubMed PubMed Citation Articles by Yan, T. D. Articles by Morris, D. L.

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

¹ Nationally Funded Peritonectomy Center, Department of Surgery, University of New South Wales, Sydney, NSW, Australia
² Department of Medical Oncology, St George Hospital, Sydney, NSW, Australia
³ Department of Anesthesiology, St George Hospital, Sydney, NSW, Australia
⁴ Intensive Care Unit, St George Hospital, Sydney, NSW, Australia
⁵ School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia

Correspondence: Address correspondence and reprint requests to: David L. Morris, MD PhD; E-mail: David.Morris{at}unsw.edu.au

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.

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

This article has been cited by other articles:

				S. ASERO, M. CARUSO, N. VALLONE, A.G. LUCIANI, V. LOMBARDO, G. TERRANOVA, G. ETTORE, and G. GIANNONE Cytoreductive Surgery (CS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Treatment of Peritoneal Surface Malignances: Report of a Phase II Clinical Study In Vivo, July 1, 2009; 23(4): 645 - 647. [Abstract] [Full Text] [PDF]

				E. A. Levine, B. M. Ronnett, P. F. Mansfield, and C. Eng Overview of Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy for Peritoneal Dissemination of Appendiceal and Colorectal Neoplasms ASCO Educational Book, January 1, 2008; 2008(1): 153 - 159. [Abstract] [Full Text] [PDF]