Andréasson H, Lorant T, Påhlman L, Graf W, Mahteme H
Department of Surgical Sciences, Uppsala University, S-751 85 Uppsala, Sweden.
Department of Surgical Sciences, Uppsala University, S-751 85 Uppsala, Sweden; Department of Surgical Sciences, Section of Transplantation Surgery, Uppsala University, Uppsala, Sweden.
Eur J Surg Oncol. 2014 Aug;40(8):930-6. doi: 10.1016/j.ejso.2014.03.001. Epub 2014 Mar 12.
Cytoreductive surgery (CRS) plus perioperative intraperitoneal chemotherapy is a highly invasive treatment of peritoneal metastasis and requires many surgical procedures before mastering. The aim of this study was to estimate how many procedures are needed before stabilization can be seen in surgical outcome (R1 surgery, adverse events and bleeding) in patients with pseudomyxoma peritonei (PMP).
All 128 patients with PMP who were treated with CRS alone or CRS plus perioperative intraperitoneal chemotherapy between 2003 and 2008 at the Uppsala University Hospital, Uppsala, Sweden, were included. The learning curve was calculated using the partial least square (PLS) and cumulative sum control chart (CUSUM) graph. Two groups were formed based on the results of the learning curve. The learning curve plateau was considered the same as the stabilization in the CUSUM graph. Group I consisted of patients included during the learning period (n = 73) and Group II of patients treated after the learning period ended (n = 55). Comparisons between the groups were made on surgical outcome, survival and adverse events.
Stabilization was seen after 220 ± 10 procedures. A higher occurrence of R1 surgery was seen in Group II (80%) compared to Group I (48%; P = 0.0002). Overall survival increased at four years after surgery in Group II compared to Group I (80% vs. 63%; P = 0.02).
CRS plus perioperative intraperitoneal chemotherapy is a highly demanding procedure that requires more than 200 procedures before optimisation in surgical outcome is seen.
细胞减灭术（CRS）联合围手术期腹腔内化疗是一种针对腹膜转移的高侵袭性治疗方法，在熟练掌握之前需要进行多次手术。本研究的目的是评估在腹膜假黏液瘤（PMP）患者中，在手术结果（R1手术、不良事件和出血）达到稳定之前需要进行多少次手术。
纳入2003年至2008年期间在瑞典乌普萨拉大学医院接受单纯CRS或CRS联合围手术期腹腔内化疗的所有128例PMP患者。使用偏最小二乘法（PLS）和累积和控制图（CUSUM）计算学习曲线。根据学习曲线结果分为两组。学习曲线平台期被认为与CUSUM图中的稳定期相同。第一组包括学习期间纳入的患者（n = 73），第二组包括学习期结束后接受治疗的患者（n = 55）。对两组患者的手术结果、生存率和不良事件进行比较。
在进行220 ± 10次手术后观察到稳定。与第一组（48%）相比，第二组（80%）的R1手术发生率更高（P = 0.0002）。与第一组相比，第二组术后四年的总生存率有所提高（80%对63%；P = 0.02）。
CRS联合围手术期腹腔内化疗是一项要求很高的手术，在手术结果得到优化之前需要进行200多次手术。
