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ANZ J Surg. 2019 Sep;89(9):1097-1101. doi: 10.1111/ans.15331. Epub 2019 Jul 7.

Accelerating the learning curve in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy using an external mentor model.

Ansari N1,2,3, Brown KGM1,2,3, McBride KE2, Steffens D1, Koh CE1,2,3, Young CJ1,2,3,4, Solomon MJ1,2,3,4, Moran BJ5.

Author information

1
Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
2
Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
3
Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
4
Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
5
Peritoneal Malignancy Institute, North Hampshire Hospital, Basingstoke, UK.

Abstract

BACKGROUND:

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is an accepted therapeutic approach in selected patients with peritoneal malignancy. The aim of this study was to describe early outcomes in the first 50 patients managed with CRS and HIPEC in a newly established peritoneal malignancy centre in Sydney, Australia, under the guidance of an experienced peritoneal malignancy mentor.

METHODS:

This is a retrospective review of a prospective maintained database of early outcomes in the first 50 patients who underwent CRS and HIPEC between April 2017 and April 2018 at a newly established peritoneal malignancy centre. Type of primary, surgery time, length of hospital stay, blood loss, peritoneal carcinomatosis index, completeness of surgery, complications, recurrence rate and 30-day mortality were reviewed.

RESULTS:

A total of 135 patients were referred and reviewed at the multidisciplinary team meeting with 50 (26 male) patients undergoing CRS and HIPEC. Of these 50 patients, 47 (94%) underwent complete cytoreduction while three (6%) had maximal tumour debulking surgery. Tumour pathology was of appendix origin (44%) and colorectal peritoneal metastases (44%). Median surgical time was 7.4 h (interquartile range 5.7-10.0). Median length of hospital stay was 13 days (interquartile range 9.7-19.0). Six (12%) patients experienced a grade III or IV Clavien-Dindo complication. There was no 30-day mortality.

CONCLUSION:

This study reports the successful establishment of a peritoneal malignancy centre under the guidance of an experienced peritoneal malignancy mentor. The short-term surgical outcomes observed in the first 50 cases are promising and comparable to other more experienced centres.

KEYWORDS:

cytoreductive surgery; hyperthermic intraperitoneal chemotherapy; learning curve

PMID:
31280498
DOI:
10.1111/ans.15331

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