This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Multicentre study of the learning curve and surgical performance of cytoreductive surgery with intraperitoneal chemotherapy for pseudomyxoma peritonei. BJS 2014; 101: 1758-1765.

Published: 20th October 2014

Authors: S. Kusamura, B. J. Moran, P. H. Sugarbaker, E. A. Levine, D. Elias, D. Baratti et al.

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.

Method

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.

Full text

You may also be interested in

Leading article

Network meta‐analysis of urinary retention and mortality after Lichtenstein repair of inguinal hernia under local, regional or general anaesthesia.

Authors: J. H. H. Olsen, S. Öberg, K. Andresen, T. W. Klausen, J. Rosenberg

Original article

Outcomes of surgery for benign and malignant adrenal disease from the British Association of Endocrine and Thyroid Surgeons’ national registry. BJS 2019; 106: 1495-1503.

Authors: N. Patel, R. J. Egan, B. R. Carter, D. M. Scott‐Coombes, M. J. Stechman, A. Afzaal et al.

Multicentre study of the learning curve and surgical performance of cytoreductive surgery with intraperitoneal chemotherapy for pseudomyxoma peritonei. BJS 2014; 101: 1758-1765.

Background

Method

Results

Conclusion

You may also be interested in

A good surgical death. BJS 2019; 106: 1427-1428.

Randomized controlled trial of plain English and visual abstracts for disseminating surgical research via social media.

Systematic review of the current status of cadaveric simulation for surgical training.

Network meta‐analysis of urinary retention and mortality after Lichtenstein repair of inguinal hernia under local, regional or general anaesthesia.

Effect of donor nephrectomy time during circulatory‐dead donor kidney retrieval on transplant graft failure.

Diagnostic performance of MRI and histology in assessment of deep lipomatous tumours.

Dysregulation of the actin scavenging system and inhibition of DNase activity following severe thermal injury.

Trauma models to identify major trauma and mortality in the prehospital setting.

5G‐assisted telementored surgery.

Validation of the Norwegian survival prediction model in trauma (NORMIT) in Swedish trauma populations.

Human model of burn injury that quantifies the benefit of cooling as a first aid measure. BJS 2019; 106: 1472-1479.

Outcomes of surgery for benign and malignant adrenal disease from the British Association of Endocrine and Thyroid Surgeons’ national registry. BJS 2019; 106: 1495-1503.