Systematic Review of Factors Affecting Quality of Life After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy

Abstract

Background. Previous studies have shown that, overall, quality of life (QoL) decreases within the first 3-6 months after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS ? HIPEC), returning to baseline levels by 6-12 months. This systematic review aims to evaluate the factors affecting QoL after CRS ? HIPEC within 12 months of surgery. Methods. Electronic databases were investigated searching for articles reporting QoL with validated questionnaires up to September 2019. Risk of bias was assessed with the methodological index for non-randomized studies tool. The primary outcomes were short-term (\ 6 months after surgery) and medium-term (6-12 months after surgery) determinants of QoL after CRS ? HIPEC. Secondary outcomes were QoL and reported symptoms over time. Results. We included 14 studies that used 12 different questionnaires. The reported data were collected prospectively or retrospectively for 1556 patients (dropout \ 50% in four studies). Overall, studies showed diminished QoL within 3 months after surgery and a recovery to baseline or greater by 12 months. QoL was negatively influenced by higher age, female sex, prolonged operation time, extensive disease, residual disease, adjuvant chemotherapy, complications, stoma placement, and recurrent disease. QoL results were comparable between studies, with dropout rates above and below 50%. Conclusions. QoL returns to baseline levels within 12 months after CRS ? HIPEC provided the disease does not recur, and this recovery process is influenced by several factors.

Two-step cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei with high peritoneal carcinomatosis index

“…Predicting resectability with preoperative imaging remains an issue [21] and the need to resect multiple organs or digestive segments [22] is particularly di cult to anticipate. Furthermore, extensive disease [23,24], prolonged operative time and postoperative complications are all factors associated with long-term impairment of quality of life [10], which has to be considered when performing CRS and HIPEC for such patients. Since the only therapeutic alternatives are debulking and systemic chemotherapy, which are both palliative options [25], CRS and HIPEC in this population may be considered in a curative intent, but only if a complete CRS is achievable with acceptable postoperative morbidity and impact on quality of life.…”

“…The peritoneal cancer index (PCI) [8] is a quantitative measure that describes the extent of peritoneal disease at surgery. A very high PCI may be considered as a contraindication for CRS, as it signi cantly increases the morbidity and mortality associated with the procedure [9], along with a signi cant impact on quality of life [10]. While CRS and HIPEC have improved oncological outcomes for patients with PMP, this procedure is associated with high operative mortality (0-18%) and morbidity (33-56%) [11][12][13][14].…”

Physical, psychological and nutritional outcomes in a cohort of Irish patients with metastatic peritoneal malignancy scheduled for cytoreductive surgery (CRS) and heated intrapertioneal chemotherapy (HIPEC): An exploratory pilot study

“…Of the 14 participants who underwent the CRS-HIPEC procedure, four were unable to attend a follow up appointment due to not being well enough (n = 2), living too far away (n = 1), and university closure/restrictions during the COVID-19 pandemic (n = 1). The median (IQR) number of weeks between CRS-HIPEC and follow-up assessment was 13 (12)(13)(14).…”

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

“…For the specific determinants, we noted that QoL was negatively influenced by higher age, female sex, prolonged operation time, extensive disease (high PCI), residual disease, adjuvant chemotherapy, postoperative complications, stoma placement, and recurrent disease. 5…”

“…Secondary outcomes were QoL and reported symptoms over time. 5 We included 14 studies that used 12 different questionnaires, and reported data were collected for 1556 patients (dropout < 50% in 4 studies). Overall, collected data showed indeed a diminished QoL within 3 months after surgery but with a recovery to baseline by 12 months.…”