Learning curve for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in peritoneal surface malignancies: Analysis of two centres

Shigeki Kusamura, Dario Baratti, Salvatore Virzì, Serena Bonomi, Domenico Rosario Iusco, Antonio Grassi, Ionut Hutanu, Marcello Deraco

Research output: Contribution to journalArticle


Background We assessed the learning curve (LC) of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in treating peritoneal surface malignancies (PSM) in two centers and evaluated in which extent surgical tutoring could abbreviate the learning process. Methods Six hundred and forty-one cases submitted to CRS using peritonectomy procedures and HIPEC were considered. After having overcome its own LC, the NCI of Milan has provided technical assistance to Bentivoglio's centre for the development of a new PSM program since 2003. The risk-adjusted sequential probability ratio test (RA-SPRT) was employed to assess the LC of the two centers. Outcomes were incomplete cytoreduction, G3-5 morbidity (NCI-CTCAE.v3) and procedure-related mortality (PRM). Results Rates of incomplete cytoreduction, G3-5 morbidity, and PRM were 8.4%, 30.1%, and 3.9%, respectively, in the entire series. The breaking points of the LC concerning incomplete cytoreduction, G3-5 morbidity, and PRM were achieved at 141, 158, and 144 cases, in the Milan's experience, and at 126, 134, and 60 cases in the Bentivoglio's experience. Conclusions Surgical tutoring could substantially shorten the steep LC associated with CRS and HIPEC. Our data should be confirmed by further studies on LC focusing oncological outcomes. Other factors that could influence the length of learning process should be identified.

Original languageEnglish
Pages (from-to)312-319
Number of pages8
JournalJournal of Surgical Oncology
Issue number4
Publication statusPublished - Mar 2013



  • cytoreductive surgery
  • hyperthermic intraperitoneal chemotherapy
  • learning curve
  • peritoneal surface malignancies
  • peritonectomy

ASJC Scopus subject areas

  • Surgery
  • Oncology

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