Table 3. Learning curve in cytoreductive surgery and HIPEC assessed by consecutive and risk-adjusted cohorts.
| Author | No. of cases for operative IP | No. of cases for oncologic IP | Statistical technique | Initial/pre inflection-point cohort |
Experienced/post inflection-point cohort |
|||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| n | Mean PCI | CC 0/1 (%) | Severe morbidity (%) | Mortality (%) | n | Mean PCI | CC 0/1 (%) | Severe morbidity (%) | Mortality (%) | |||||
| Consecutive cohorts | ||||||||||||||
| Yan et al. (25) | − | − | Longitudinal cohort study | 70 | − | 87 | 30.0 | 7.1 | 70 | − | 90 | 10 | 1.4 | |
| Moran et al. a (13) | − | − | Longitudinal cohort study | 33 | − | 66.6 | 27 | 18 | 34 | − | 55.9 | 0 | 3 | |
| Smeenk et al. (24) | 130 | − | Longitudinal cohort study | 194 | 9.5 | − | 59.8 | 6.7 | 129 | 7 | − | 34.1 | 3.9 | |
| Risk-adjusted cohorts | ||||||||||||||
| Polanco et al. b (27) | 180 | 90 | RA-SPRT | 200 | 14.2 | 83.5 | 25.5 | − | 170 | 12.2 | 86 | 35.2 | − | |
| Andreasson et al. c (26) | 73 (220 procedures) | − | PLS & CUSUM | 73 | 26 | − | 47 | 1.4 | 55 | 26 | − | 58 | 1.8 | |
| Kusamura et al. (11) | 140 | − | RA-SPRT | 150 | 18.1 | 82 | 26 | − | 270 | 18.8 | 93.6 | 29.6 | − | |
a, initial and experienced cohorts are first 33 and last 34 cases of a consecutive 100 case series; b, reported simplified PCI score. Instances of mortality were not included in the learning curve analysis; c, median PCI score reported. Morbidity not classified into severe. Cases consisted of pseudomyxoma peritonei and experienced cohort had less cases of higher grade disease. HIPEC, hyperthermic intraperitoneal chemoperfusion; IP, inflection point; PCI, peritoneal cancer index; CC, completion of cytoreduction scoring system; RA-SPRT, risk adjusted sequential probability ratio test; PLS, partial least square; CUSUM, cumulative sum control chart.