Impact of Major Complications on Patients' Quality of Life After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Our plain-English summary of Impact of Major Complications on Patients' Quality of Life After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy, by T.D. Hamilton, E.L. Taylor, A.J. Cannell, et al (Annals of Surgical Oncology, 2016).

The study

• Authors: T.D. Hamilton, E.L. Taylor, A.J. Cannell, J.A. McCart, A. Govindarajan
• Journal: Annals of Surgical Oncology
• Published: 2016;23(9):2946-52
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is an effective treatment for selected patients with peritoneal surface malignancies (PSM). Although it can have significant morbidity, perioperative mortality is low. Little is known about whether major complications after CRS/HIPEC have a lasting impact on patients' quality of life (QOL).

Methods: We retrospectively reviewed data from a prospectively collected database on patients treated with CRS/HIPEC for PSM (2011-2014). Patients with CRS/HIPEC and 6-month QOL evaluation were included. Major perioperative complications (Clavien-Dindo grade 3/4) were the primary independent variable. QOL was evaluated using the validated EORTC QLQ-C30 score. The primary outcome was 6-month global health score. Secondary outcomes were individual functional and symptom domains.

Results: Forty-two patients were analyzed. Median age was 57.5; 64 % were female. Origin of PSM was appendix (55 %), colorectal (38 %), mesothelioma (5 %), and small bowel (2 %). Fourteen patients (33 %) had major (grade 3/4) complications. Median length of stay was 16 days; patients experiencing major complications had significantly increased length of stay (35.5 vs. 13 days, p < 0.01). Major complications included intra-abdominal abscess (9.5 %), bleeding (9.5 %), symptomatic pleural effusion (7.1 %), anastomotic leaks (7.1 %), and renal failure (2.4 %). The average global health score at 6 months was 68.1. The worst-rated symptom scores at 6 months were diarrhea (39.8) and fatigue (35.4). There were no significant differences in 6-month QOL scores between patients with and without major complications, globally or in specific domains.

Conclusions: Although major complications are common after CRS/HIPEC, QOL at 6 months recovers and is similar to those without major complications.

In plain English

This study from Mount Sinai Hospital in Toronto, Canada asked whether serious complications after a major cancer operation affected patients' quality of life six months later. The operation, called CRS/HIPEC, combined surgery with heated chemotherapy in the abdomen. It was used for cancers affecting the lining of the abdomen. Of 87 patients treated between September 2011 and October 2014, 42 filled out a standard quality-of-life questionnaire at six months and were studied. Two of them had mesothelioma; most of the others had appendix or colorectal cancer. The article does not discuss asbestos. Fourteen of the 42 (33.3%) had major complications. Their median hospital stay was 35.5 days, against 13 days for the others. At six months, overall health scores averaged 62.5 in patients with major complications and 70.8 in those without. The difference was not statistically significant (p = 0.16), and no other area of the questionnaire differed significantly. The authors concluded that major complications did not significantly impair quality of life at six months. They noted that the sample was small and came from one hospital, that patients were measured at only one time point, and that there was no questionnaire before surgery.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective cohort study using a prospectively collected database at a single institution
• Who was studied: 42 of 87 patients treated with CRS/HIPEC for peritoneal surface malignancy at Mount Sinai Hospital, Toronto, September 2011 to October 2014, who completed the 6-month quality-of-life questionnaire. Primary sites: appendix 23 (54.8%), colon 16 (38.1%), mesothelioma 2 (4.8%), small bowel 1 (2.4%).
• Exposure: The factor studied was having a major complication (Clavien-Dindo grade 3 or 4) within 30 days or in hospital after CRS/HIPEC. No asbestos exposure was studied or discussed.
• Main results:
  • 14 of 42 patients (33.3%) had major complications.
  • Median hospital stay was 35.5 days for patients with major complications versus 13 days for those without, a difference reported as significant.
  • Mean global health score at 6 months was 62.5 for patients with major complications and 70.8 for those without (mean difference 8.3, p = 0.16), which was not statistically significant.
  • No significant differences were found between the groups in any functional or symptom domain.
  • Across all 42 patients, the average global health score at 6 months was 68.1. The worst-rated symptoms were diarrhea (39.8) and fatigue (35.4); for symptom scores, lower means less severe.
  • Patients with major complications were more often female (85.7% vs. 53.6%, p = 0.04) and more often received intraperitoneal oxaliplatin (78.6% vs. 46.4%, p = 0.05).
  • Extending the complication window to 90 days identified no additional patients with grade 3 or 4 complications.
• The authors' conclusion: The authors concluded that major perioperative complications were associated with more interventions and significantly longer hospital stays, but did not significantly impair quality of life at 6 months. They called for a larger study with multiple time points.
• Limitations the authors state:
  • The study came from a single tertiary care institution and had a modest sample size.
  • A larger sample might have shown smaller but statistically significant differences.
  • Quality of life was measured at only one time point, 6 months.
  • There was no quality-of-life assessment before surgery.
  • Excluding patients who did not complete the questionnaire could introduce nonresponse bias. The authors judged this unlikely because the excluded patients had similar baseline characteristics and few major complications.

Topics

Medical terms in this study, explained in our Lexicon: Quality of Life, Cytoreductive Surgery, HIPEC, Mesothelioma, Pleural Effusion.

Related studies

• A Novel Tool for Predicting Major Complications After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy — J.M. Baumgartner, T.G. Kwong, et al. (2016)
• Quality of life after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: a prospective study of 216 patients — G. Passot, N. Bakrin, et al. (2014)
• Quality of life in patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: is it worth the risk? — N. Tsilimparis, C. Bockelmann, et al. (2013)
• Association between hospital finances, payer mix, and complications after hyperthermic intraperitoneal chemotherapy: deficiencies in the current healthcare reimbursement system and future implications — M.H. Squires, C.A. Staley, et al. (2015)
• Urological approach for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in a clinical care center — C.G. Trujillo, C. Domínguez, et al. (2018)
• The Role of Ki-67 and Pre-cytoreduction Parameters in Selecting Diffuse Malignant Peritoneal Mesothelioma (DMPM) Patients for Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) — S. Kusamura, P.A. Torres Mesa, et al. (2016)

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