Learning curve, training program, and monitorization of surgical performance of PSM centers.

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Abstract

Cytoreductive surgery (CRS) and HIPEC is a complex procedure with high cost and significant morbidity and mortality. The associated learning curve (LC) is steep and could reliably be evaluated using specific statistics. The Risk adjusted sequential probability ratio test is an effective and robust method to monitor surgical performance both in the learning and audit phase of a PSM center development. Several factors are associated with surgical performance and the most critical is mentoring of the trainee by an expert. Rare PSM like PMP and peritoneal mesothelioma are specific clinical circumstances that require further effort in the training process. Their extremely low incidences make reasonable regional centralization to ease centers’ quality control and improve cost effectiveness. A well-structured tutor based training program has been implemented in Europe. This initiative is expected to improve the standardization of the combined procedure and improve the quality of the services across the continent