ASO Author Reflections: A Systematic Review of Factors Affecting Quality of Life After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy

Abstract

Only 3 decades ago, patients with peritoneal metastasis, either metachronous or synchronous, were considered incurable and suitable only for palliative treatment. Back then, if left untreated, peritoneal metastasized patients had poor prognosis, high morbidity, and reduced quality of life (QoL). 1 Fortunately, a curative-intent treatment option arose: cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC). This suddenly gave patients with resectable peritoneal metastasis (PM) the option of undergoing a potentially curative treatment. CRS/HIPEC combines surgical removal of all macroscopically visible disease with perfusion of the abdominal cavity with heated chemotherapy to eradicate residual microscopic disease. After its introduction, cumulative scientific evidence seemed to illustrate improved survival outcomes when compared with systemic chemotherapy alone. 2 If selected carefully, e.g., without distant metastases, aggressive CRS/HIPEC seemed to be a potentially curative treatment for 30-40% of patients. Unfortunately, today, this invasive procedure is still accompanied by a high treatment-related mortality of 0-8%, a grade 3-4 morbidity of 18-52%, and a negative impact on QoL of patients up to 1 year after. 3 Since the majority of patients undergoing CRS/HIPEC will not be cured by this procedure, the high morbidity rates are an ongoing concern.