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

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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ACKNOWLEDGMENTS

The authors indicate that there are no potential conflicts of interests. Authors thank Jing Zhao, MD, for maintaining the peritonectomy database.

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Authors and Affiliations

  1. Nationally Funded Peritonectomy Center, Department of Surgery, University of New South Wales, Sydney, NSW, Australia

    Tristan D. Yan BSc (Med) MBBS, Vanessa Saunders BNMN & David L. Morris MD PhD

  2. Department of Medical Oncology, St George Hospital, Sydney, NSW, Australia

    Matthew Links MBBS PhD

  3. Department of Anesthesiology, St George Hospital, Sydney, NSW, Australia

    Sal Fransi MBBS

  4. Intensive Care Unit, St George Hospital, Sydney, NSW, Australia

    Theresa Jacques MBBS

  5. School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia

    Deborah Black BSc DipEd MStat PhD

Authors
  1. Tristan D. Yan BSc (Med) MBBS
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  2. Sal Fransi MBBS
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  3. Theresa Jacques MBBS
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  4. Deborah Black BSc DipEd MStat PhD
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  5. Vanessa Saunders BNMN
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  6. David L. Morris MD PhD
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Corresponding author

Correspondence to David L. Morris MD PhD.

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Yan, T.D., Links, M., Fransi, S. et al. Learning Curve for Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Peritoneal Surface Malignancy—A Journey to Becoming a Nationally Funded Peritonectomy Center. Ann Surg Oncol 14, 2270–2280 (2007). https://doi.org/10.1245/s10434-007-9406-8

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  • DOI: https://doi.org/10.1245/s10434-007-9406-8

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