Improved Survival with Experience: A 10-Year Learning Curve in Hyperthermic Intraperitoneal Chemotherapy and Cytoreductive Surgery

Background Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is an aggressive locoregional treatment for peritoneal carcinomatosis (PC). Studies demonstrate improved perioperative and oncologic outcomes at high-volume centers. Methods This study retrospectively analyzed all patients with PC from various malignancies who underwent attempted CRS/HIPEC at the authors’ institution from 2007 to 2017. Clinicopathologic, perioperative, and oncologic outcomes of early (2007–2012) and late (2012–2017) experience were compared, and multivariate analyses for factors predictive of perioperative and oncologic outcomes were performed. Results The study enrolled 388 patients (157 early and 231 late). The late experience contained more appendiceal low-grade mucinous neoplasms (LGMNs; 21% vs 9%) and had a lower Peritoneal Cancer Index (PCI; 10 vs 16). Moreover, achieving a similar rate of CC-0/1 required fewer organ resections, involved shorter operations (298 vs 347 min), and had lower estimated blood loss (EBL) (400 vs 200 ml) ( p