Abstract
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.
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 2 years 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 84·4, 25·7 and 29·0 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.
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.
| Original language | English |
|---|---|
| Pages (from-to) | 1758-1765 |
| Number of pages | 8 |
| Journal | British Journal of Surgery |
| Volume | 101 |
| Issue number | 13 |
| DOIs | |
| State | Published - Dec 1 2014 |
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All Science Journal Classification (ASJC) codes
- Surgery
- Medicine(all)
Cite this
Multicentre study of the learning curve and surgical performance of cytoreductive surgery with intraperitoneal chemotherapy for pseudomyxoma peritonei. / Kusamura, S.; Moran, B. J.; Sugarbaker, P. H.; Levine, E. A.; Elias, D.; Baratti, D.; Morris, D. L.; Sardi, A.; Glehen, O.; Deraco, M.; Gilly, F. N.; Barrios, P.; Quenet, F.; Loggie, Brian W.; Gómez Portilla, A.; De Hingh, I. H J T; Ceelen, W. P.; Pelz, J. O W; Piso, P.; González-Moreno, S.; Van Der Speeten, K.; Chua, T. C.; Yan, T. D.; Liauw, W.
In: British Journal of Surgery, Vol. 101, No. 13, 01.12.2014, p. 1758-1765.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Multicentre study of the learning curve and surgical performance of cytoreductive surgery with intraperitoneal chemotherapy for pseudomyxoma peritonei
AU - Kusamura, S.
AU - Moran, B. J.
AU - Sugarbaker, P. H.
AU - Levine, E. A.
AU - Elias, D.
AU - Baratti, D.
AU - Morris, D. L.
AU - Sardi, A.
AU - Glehen, O.
AU - Deraco, M.
AU - Gilly, F. N.
AU - Barrios, P.
AU - Quenet, F.
AU - Loggie, Brian W.
AU - Gómez Portilla, A.
AU - De Hingh, I. H J T
AU - Ceelen, W. P.
AU - Pelz, J. O W
AU - Piso, P.
AU - González-Moreno, S.
AU - Van Der Speeten, K.
AU - Chua, T. C.
AU - Yan, T. D.
AU - Liauw, W.
PY - 2014/12/1
Y1 - 2014/12/1
N2 - 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.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 2 years 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 84·4, 25·7 and 29·0 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.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.
AB - 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.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 2 years 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 84·4, 25·7 and 29·0 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.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.
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U2 - 10.1002/bjs.9674
DO - 10.1002/bjs.9674
M3 - Article
VL - 101
SP - 1758
EP - 1765
JO - British Journal of Surgery
JF - British Journal of Surgery
SN - 0007-1323
IS - 13
ER -