The Importance of the Learning Curve and Surveillance of Surgical Performance in Peritoneal Surface Malignancy Programs

Kusamura, Shigeki; Baratti, Dario; Huțanu, Ionuț; Rossi, Piero; Deraco, Marcello

doi:10.1016/j.soc.2012.07.011

Cited by 29 publications

(25 citation statements)

References 43 publications

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“…The results of the largest study which included 405 patients showed a 3 and 5 years survival rates of 60 and 47%, the best prognostic factors being: the epithelioid subtype, the absence of lymph nodes metastasis, optimal cytoreduction and the hyperthermic intraperitoneal chemotherapy [17]. Morbidity and mortality rates for this highly demanding surgery are 39 and 2% [18], with a long learning curve [19] and with high costs [20]. It is difficult to evaluate the benefits of this intervention in our patient, without the appropriate diagnosis the patient was not referred to a specialized center.…”

Section: Discussionmentioning

confidence: 99%

Rare localization of malignant peritoneal mesothelioma

Huțanu¹,

Filip²,

Buna³

et al. 2015

Arch Clin Cases

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Peritoneal mesothelioma represents a rare disease, among its manifestations it can be encountered ascites and tumoral abdominal masses and this condition, untreated can lead to death by bowel obstruction, perforation and cachexia. Due to the rarity of the disease, some patients are misdiagnosed and thus they cannot benefit from a radical form of treatment which leads to an increased survival. We hereby present the case of a 62 year-old male with previous surgery for a retroperitoneal tumor with relapse of the disease. The pathological examination and immunochemistry showed a diffuse peritoneal mesothelioma with poor differentiation. The patient was submitted to chemotherapy and 16 months after surgery on regular control imaging he presented a retroperitoneal recurrence. Unfortunately the patient refused the treatment; we believe that he could benefit from radical surgery associated with hyperthermic intraperitoneal chemotherapy. Preoperative diagnosis of diffuse peritoneal mesothelioma can be difficult due to the lowest predictability of the clinical and imaging studies.

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Section: Discussionmentioning

confidence: 99%

Rare localization of malignant peritoneal mesothelioma

Huțanu¹,

Filip²,

Buna³

et al. 2015

Arch Clin Cases

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“…It is possible to eventually reduce morbidity and mortality rates in experienced centres to those similar to a Whipple's resection, (45) leading to improved survival outcomes. (46,47) Kusamura et al's paper describes a surgical team or institution as having proficiency at CRS and HIPEC after they have completed 140 cases. (18,46) CONCLUSION PM are a common endpoint for many gastrointestinal cancers and often occur together with debilitating symptoms.…”

Section: Other Considerationsmentioning

confidence: 99%

“…(46,47) Kusamura et al's paper describes a surgical team or institution as having proficiency at CRS and HIPEC after they have completed 140 cases. (18,46) CONCLUSION PM are a common endpoint for many gastrointestinal cancers and often occur together with debilitating symptoms. CRS and HIPEC have been proven to improve survival outcomes with acceptable morbidity and mortality.…”

Section: Other Considerationsmentioning

confidence: 99%

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in gastrointestinal cancers: fad or standard of care?

Teo

Tan

2018

smedj

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Peritoneal metastases (PM) are the common endpoint for patients with advanced gastrointestinal cancers.PM from these cancers are often managed in a similar fashion to other sites of systemic metastases, but the following must be taken into consideration. (a) PM do not respond to systemic chemotherapy in the same fashion as liver and lung metastases. (b) PM cause local problems, resulting in disruption of chemotherapy. (c) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) actually work for PM. (d) PM are not easily detected on imaging modalities. There has been mounting evidence of the effectiveness of CRS-HIPEC at prolonging survival in selected patients with colorectal and gastric PM, but there remains a reluctance to explore this treatment modality. This is likely because of the perceived morbidity and mortality. An effective management strategy employing CRS-HIPEC for selected patients with gastrointestinal PM can only be achieved if a concerted effort is made to understand this disease and address the concerns regarding this treatment.

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“…In the many papers published on this topic, it is evident that the latter part of an institution's experience with this procedure yields better results in terms of morbidity and mortality statistics, as well as survival results [13,14]. This is often attributed to the increased familiarity of the surgical team to the procedure, and also to the maturation in the selection critieria and protocols 19,20 .…”

Section: Learning Curvementioning

confidence: 99%

Cytoreductive Surgery and HIPEC for Colorectal Cancer: Facing the Facts and Addressing the Issues to Allow for Widespread Acceptance

Ching¹,

Ching²

2015

Arch Can Res

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Abstract60% of colorectal cancers are diagnosed at an advanced stage. Curative strategies involving multimodality treatment with surgical resection and chemotherapy have been employed for liver and lung metastases from colorectal cancer.Peritoneal metastases are diagnosed synchronously in 10-15% of all newly diagnosed colorectal cancer, and in 40-70% of patients who suffer a recurrence. They are the sole sites of metastases in 10-30% of these cases. An understanding of peritoneal metastases must take into consideration the following:1. Peritoneal metastases do not respond to systemic chemotherapy in the same fashion as liver and lung metastases 2. Peritoneal disease causes many local problems, resulting in disruption of planned chemotherapy 3. CRS and HIPEC actually works for peritoneal disease and 4. Peritoneal disease is usually not detected on state-of-the-art imaging modalities.Despite mounting evidence of the effectiveness of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS and HIPEC) at prolonging survival in selected patients with colorectal peritoneal carcinomatosis, there remains a reluctance to explore this combined treatment modality. This is likely to be a result of the perceived morbidity and mortality of such a procedure, with most medical oncologists and colorectal surgeons being unfamiliar with the combined treatment. As with all complex procedures, a learning curve is observed, with proficiency likely only after 25 cases and at a high volume centre, with more than 30 cases annually.An effective management strategy employing CRS and HIPEC for selected patients with colorectal peritoneal carcinomatosis can only be achieved if a concerted effort is made to understand this disease and address the concerns regarding this treatment.

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The Importance of the Learning Curve and Surveillance of Surgical Performance in Peritoneal Surface Malignancy Programs

Cited by 29 publications

References 43 publications

Rare localization of malignant peritoneal mesothelioma

Rare localization of malignant peritoneal mesothelioma

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in gastrointestinal cancers: fad or standard of care?

Cytoreductive Surgery and HIPEC for Colorectal Cancer: Facing the Facts and Addressing the Issues to Allow for Widespread Acceptance

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