Impact of Surgical Volume and Learning Curve on Postoperative Complications and Surgical Infections After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC).
Abstract:
Introduction Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a standard of care for patients with peritoneal metastasis. It can significantly prolong the survival of patients, but at the same time may increase the risk of postoperative complications and infections.
Patients and Methods
We retrospectively analyzed 1,350 patients who underwent CRS+HIPEC. We divided in three time periods patients from three different centers, all patients being operated by the same chief surgeon. We analyzed the impact of the number of cases and the learning curve in the postoperative compli-cation and the common sites of postoperative infections and the results of microbial culture.
Results
Complication reduction commensurate with the learning curve. From Table 1 the data shows a clear improvement in patient outcomes over time, reflecting the impact of the learning curve: • Mortality: Decreased from 8.1% (2005-2010) to 2.5% (2017-2024), indicating better survival rates as experi ence increased. • Morbidity: Dropped from 40.7% to 16.75% over the same periods, showing fewer complications and improved patient care. As we can see in Table 2,3 the most serious complications for patients who underwent CRS + HIPEC are infections, affecting 37.7% of patients, with Staphylococcus epidermidis and E. Coli as the most frequently isolated pathogens. As expertise and practices improved, the rates are demonstrating the positive effects of the learning curve on health care outcomes. In the first 5-year period the percentage of infections complication was 62,6% while in both other periods reduced in 31,5%.
