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Institutional Learning Curve of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion for Peritoneal Malignancies

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

Abstract

Background

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemoperfusion (HIPEC) is routinely used to treat certain peritoneal carcinomatoses (PC), but it can be associated with relatively high complication rates, prolonged hospital length of stay, and potential mortality. Our objective was to determine the learning curve (LC) of CRS/HIPEC in our high-volume institution.

Methods

A total of 370 patients with PC from mucinous appendiceal neoplasms (MAN = 282), malignant peritoneal mesothelioma (MPM = 60), and gastric cancer (GC = 24) were studied. Outcomes analyzed included incomplete cytoreduction (IC), severe morbidity (SM), 60-day mortality, progression-free survival (PFS), and overall survival (OS). Risk-adjusted sequential probability ratio test (RA-SPRT) was employed to assess the LC of CRS/HIPEC for IC and SM using prespecified odds ratio (OR) boundaries derived from previously published data. Risk adjusted-cumulative average probability (RA-CAP) was used to analyze 1-year PFS and 2-year OS.

Results

Complete cytoreduction, severe morbidity, and 60-day mortality were 84.2, 30, and 1.9 % respectively. Higher simplified peritoneal cancer index was the major independent risk factor for IC, whereas high-grade histology, IC, and diagnosis of MPM and GC (compared with MAN) were predictors of SM after CRS/HIPEC (p < 0.05). RA-SPRT showed that approximately 180 cases are needed to achieve the lowest risk of IC and SM. Ninety cases were needed to achieve a steady 1-year PFS and 2-year OS in RA-CAP plots.

Conclusions

The completeness of cytoreduction, morbidity, and mortality rates for CRS/HIPEC at our institution are comparable to previously reported data. Approximately 180 and 90 procedures are required to improve operative and oncologic outcomes respectively.

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Authors and Affiliations

  1. Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Patricio M. Polanco MD, Jordan M. Knox BA, Lekshmi Ramalingam MD, Heather Jones MPA-C, Melissa E. Hogg MD, Amer H. Zureikat MD, Matthew P. Holtzman MD, James Pingpank MD, Steven Ahrendt MD, Herbert J. Zeh MD, David L. Bartlett MD & Haroon A. Choudry MD

  2. Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA

    Ying Ding PhD

Authors
  1. Patricio M. Polanco MD
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  2. Ying Ding PhD
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  3. Jordan M. Knox BA
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  4. Lekshmi Ramalingam MD
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  5. Heather Jones MPA-C
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  6. Melissa E. Hogg MD
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  7. Amer H. Zureikat MD
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  8. Matthew P. Holtzman MD
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  9. James Pingpank MD
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  10. Steven Ahrendt MD
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  11. Herbert J. Zeh MD
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  12. David L. Bartlett MD
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  13. Haroon A. Choudry MD
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Corresponding authors

Correspondence to David L. Bartlett MD or Haroon A. Choudry MD.

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Polanco, P.M., Ding, Y., Knox, J.M. et al. Institutional Learning Curve of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion for Peritoneal Malignancies. Ann Surg Oncol 22, 1673–1679 (2015). https://doi.org/10.1245/s10434-014-4111-x

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  • DOI: https://doi.org/10.1245/s10434-014-4111-x

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