Multicentre study of the learning curve and surgical performance of cytoreductive surgery with intraperitoneal chemotherapy for pseudomyxoma peritonei.

MedStar author(s):
Citation: British Journal of Surgery. 101(13):1758-65, 2014 Dec.PMID: 25329419Institution: MedStar Washington Hospital CenterDepartment: Surgery/General SurgeryForm of publication: Journal ArticleMedline article type(s): Journal Article | Multicenter StudySubject headings: *Antineoplastic Combined Chemotherapy Protocols/ad [Administration & Dosage] | *Clinical Competence/st [Standards] | *Cytoreduction Surgical Procedures/st [Standards] | *Learning Curve | *Peritoneal Neoplasms/su [Surgery] | *Pseudomyxoma Peritonei/su [Surgery] | Chemotherapy, Cancer, Regional Perfusion/mt [Methods] | Combined Modality Therapy/mt [Methods] | Cytoreduction Surgical Procedures/ed [Education] | Female | Humans | Hyperthermia, Induced/mt [Methods] | Male | Middle Aged | Peritoneal Neoplasms/dt [Drug Therapy] | Pseudomyxoma Peritonei/dt [Drug Therapy] | Retrospective StudiesYear: 2014ISSN:
  • 0007-1323
Name of journal: The British journal of surgeryAbstract: BACKGROUND: The learning curves for cytoreductive surgery with intraperitoneal chemotherapy for treatment of pseudomyxoma peritonei (PMP) were explored between international centres/surgeons to identify institutional or other factors that might affect performance.CONCLUSION: The learning curve is extremely long, so centralization and/or networking of centres is necessary to assure quality of services. One centre for every 10-15 million inhabitants would be ideal.Copyright � 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd.METHODS: Data from patients with PMP treated with the combined procedure across 33 international centres between 1993 and 2012 were analysed retrospectively. A risk-adjusted sequential probability ratio test was conducted after defining the target outcome as early oncological failure (disease progression within 2years of treatment), an acceptable risk for the target outcome (odds ratio) of 2, and type I/II error rates of 5 per cent. The risk prediction model was elaborated and patients were evaluated sequentially for each centre/surgeon. The learning curve was considered to be overcome and proficiency achieved when the odds ratio for early oncological failure became smaller than 2.RESULTS: Rates of optimal cytoreduction, severe postoperative morbidity and early oncological failure were 844, 257 and 290 per cent respectively. The median annual centre volume was 17 (range 6-66) peritoneal malignancies. Only eight of the 33 centres and six of 47 surgeons achieved proficiency after a median of 100 (range 78-284) and 96 (86-284) procedures respectively. The most important institutional factor affecting surgical performance was centre volume.All authors: Baratti D, Deraco M, Elias D, Glehen O, Kusamura S, Levine EA, Moran BJ, Morris DL, Peritoneal Surface Oncology Group International (PSOGI), Sardi A, Sugarbaker PHFiscal year: FY2015Digital Object Identifier: Date added to catalog: 2015-03-17
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 25329419 Available 25329419

BACKGROUND: The learning curves for cytoreductive surgery with intraperitoneal chemotherapy for treatment of pseudomyxoma peritonei (PMP) were explored between international centres/surgeons to identify institutional or other factors that might affect performance.

CONCLUSION: The learning curve is extremely long, so centralization and/or networking of centres is necessary to assure quality of services. One centre for every 10-15 million inhabitants would be ideal.Copyright � 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd.

METHODS: Data from patients with PMP treated with the combined procedure across 33 international centres between 1993 and 2012 were analysed retrospectively. A risk-adjusted sequential probability ratio test was conducted after defining the target outcome as early oncological failure (disease progression within 2years of treatment), an acceptable risk for the target outcome (odds ratio) of 2, and type I/II error rates of 5 per cent. The risk prediction model was elaborated and patients were evaluated sequentially for each centre/surgeon. The learning curve was considered to be overcome and proficiency achieved when the odds ratio for early oncological failure became smaller than 2.

RESULTS: Rates of optimal cytoreduction, severe postoperative morbidity and early oncological failure were 844, 257 and 290 per cent respectively. The median annual centre volume was 17 (range 6-66) peritoneal malignancies. Only eight of the 33 centres and six of 47 surgeons achieved proficiency after a median of 100 (range 78-284) and 96 (86-284) procedures respectively. The most important institutional factor affecting surgical performance was centre volume.

English

Powered by Koha