Table 5. Strategies to reduce the time to achieving the inflection point on the learning curve for performing CRS + HIPEC.

Improve surgical proficiency

Establish training programs at high volume centers

Improve patient selection via dissemination of knowledge

Improve current levels of evidence of studies that guide patient care

Surgical workshops and mentorship

Consider a volume cut off for basic proficiency skills to be maintained every year

Improve systems of care

Create systems of care including checklists for peri-operative services (anesthesia, nursing, critical care, pathology, integrative medicine, cancer supportive services, palliative care)

Create continuum of learning for peri-operative services

Mentorship amongst peri-operative service between established centers and newly developing centers

Reporting of data

Continuous reporting of data via registry mechanisms to facilitate quality improvement

CRS, cytoreductive surgery; HIPEC, hyperthermic intra-peritoneal chemoperfusion.