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Cytoreductive surgery and intraperitoneal chemotherapy for peritoneal malignancy—outcomes and learning curves in medium volume center

Algethami, N. LU ; Valdimarsson, V. LU orcid ; Thorlacius, H. LU ; Verwaal, V. LU and Syk, I. LU (2025) In Scandinavian Journal of Surgery p.1-12
Abstract

Introduction: Implementing new treatment regimens entails a learning phase with a concomitant risk of suboptimal results. High caseload has generally been shown to improve results in complex surgical procedures. This study aimed to evaluate results of Cytoreductive Surgery (CRS) and Intraperitoneal Chemotherapy (IP), given as Early Postoperative Intraperitoneal Chemotherapy (EPIC) or Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in a mid-size volume center, stratified by time periods. Method: This retrospective single-center cohort study included all CRS-IP procedures in Malmö, Sweden. All data were retrieved from a prospective quality control registry. Primary outcomes were: 5-year overall survival (5-Yr OS) and 30-day severe and... (More)

Introduction: Implementing new treatment regimens entails a learning phase with a concomitant risk of suboptimal results. High caseload has generally been shown to improve results in complex surgical procedures. This study aimed to evaluate results of Cytoreductive Surgery (CRS) and Intraperitoneal Chemotherapy (IP), given as Early Postoperative Intraperitoneal Chemotherapy (EPIC) or Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in a mid-size volume center, stratified by time periods. Method: This retrospective single-center cohort study included all CRS-IP procedures in Malmö, Sweden. All data were retrieved from a prospective quality control registry. Primary outcomes were: 5-year overall survival (5-Yr OS) and 30-day severe and total postoperative complication rates. Secondary outcomes were: recurrence rate, 3-year disease-free survival (DFS), and 90-day mortality rate. Outcomes were analyzed by time periods divided into initiating phase (n = 56) and established phase (n = 208). Results: In total 264 CRS-IP in 240 patients were performed from 2004 to 2021 (35 EPIC, 229 HIPEC). The 5-Yr OS after primary CRS-IP was 43% in colorectal cancer (n = 169) and 87% in pseudomyxoma (n = 53). In pmCRC, the 5-year OS was significantly lower in the initiation phase (29%) compared to the established phase (48%), verified in an adjusted multivariable analysis showing a hazard ratio of 0.51 for mortality in the established phase. The risk of recurrence did however not differ. Total 30-day complication rate was 67%, severe complication rate 15% and 90-day mortality was 1%. None of which differed depending on time period in multivariable analysis. Conclusion: Our results for both pseudomyxoma peritonei (PMP) and pmCRC are in line with previously published results, implying that high volume is not a prerequisite for high-quality CRS-IP. Although long-term survival in pmCRC was significantly better in the established phase, recurrence rates remained unchanged. Further, postoperative mortality and risk of complications did not differ between time periods, suggesting that the impact of the learning curve was limited.

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; ; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
Cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, learning curve, peritoneal carcinomatosis, survival
in
Scandinavian Journal of Surgery
pages
1 - 12
publisher
Finnish Surgical Society
external identifiers
  • scopus:105024873713
  • pmid:41399005
ISSN
1457-4969
DOI
10.1177/14574969251397312
language
English
LU publication?
yes
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Publisher Copyright: © The Finnish Surgical Society 2025. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
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27ec6c92-d127-4aa4-8a30-269ca7e1a613
date added to LUP
2026-02-24 13:08:49
date last changed
2026-02-25 06:57:36
@article{27ec6c92-d127-4aa4-8a30-269ca7e1a613,
  abstract     = {{<p>Introduction: Implementing new treatment regimens entails a learning phase with a concomitant risk of suboptimal results. High caseload has generally been shown to improve results in complex surgical procedures. This study aimed to evaluate results of Cytoreductive Surgery (CRS) and Intraperitoneal Chemotherapy (IP), given as Early Postoperative Intraperitoneal Chemotherapy (EPIC) or Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in a mid-size volume center, stratified by time periods. Method: This retrospective single-center cohort study included all CRS-IP procedures in Malmö, Sweden. All data were retrieved from a prospective quality control registry. Primary outcomes were: 5-year overall survival (5-Yr OS) and 30-day severe and total postoperative complication rates. Secondary outcomes were: recurrence rate, 3-year disease-free survival (DFS), and 90-day mortality rate. Outcomes were analyzed by time periods divided into initiating phase (n = 56) and established phase (n = 208). Results: In total 264 CRS-IP in 240 patients were performed from 2004 to 2021 (35 EPIC, 229 HIPEC). The 5-Yr OS after primary CRS-IP was 43% in colorectal cancer (n = 169) and 87% in pseudomyxoma (n = 53). In pmCRC, the 5-year OS was significantly lower in the initiation phase (29%) compared to the established phase (48%), verified in an adjusted multivariable analysis showing a hazard ratio of 0.51 for mortality in the established phase. The risk of recurrence did however not differ. Total 30-day complication rate was 67%, severe complication rate 15% and 90-day mortality was 1%. None of which differed depending on time period in multivariable analysis. Conclusion: Our results for both pseudomyxoma peritonei (PMP) and pmCRC are in line with previously published results, implying that high volume is not a prerequisite for high-quality CRS-IP. Although long-term survival in pmCRC was significantly better in the established phase, recurrence rates remained unchanged. Further, postoperative mortality and risk of complications did not differ between time periods, suggesting that the impact of the learning curve was limited.</p>}},
  author       = {{Algethami, N. and Valdimarsson, V. and Thorlacius, H. and Verwaal, V. and Syk, I.}},
  issn         = {{1457-4969}},
  keywords     = {{Cytoreductive surgery; hyperthermic intraperitoneal chemotherapy; learning curve; peritoneal carcinomatosis; survival}},
  language     = {{eng}},
  pages        = {{1--12}},
  publisher    = {{Finnish Surgical Society}},
  series       = {{Scandinavian Journal of Surgery}},
  title        = {{Cytoreductive surgery and intraperitoneal chemotherapy for peritoneal malignancy—outcomes and learning curves in medium volume center}},
  url          = {{http://dx.doi.org/10.1177/14574969251397312}},
  doi          = {{10.1177/14574969251397312}},
  year         = {{2025}},
}