The importance of the learning curve and surveillance of surgical performance in peritoneal surface malignancy programs.

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are complex procedures with a very steep a learning curve (LC). This study evaluates the LC of CRS and HIPEC in a single-center experience of peritoneal surface malignancies (PSMs). Approximately 140 to 150 cases were necessary for the acquisition of competence in CRS and HIPEC with adequate radicality and acceptable safety. Eighty to 100 cases were necessary to assure short-term prognostic gains in rare PSMs. This article highlights how LC and continuous monitoring of surgical performance is critical in evaluating the credibility of emerging and already established PSM centers.