Quality of life after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: a prospective study of 216 patients

Our plain-English summary of Quality of life after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: a prospective study of 216 patients, by G. Passot, N. Bakrin, A.S. Roux, et al (European Journal of Surgical Oncology, 2014).

The study

• Authors: G. Passot, N. Bakrin, A.S. Roux, D. Vaudoyer, F.N. Gilly, O. Glehen, E. Cotte
• Journal: European Journal of Surgical Oncology
• Published: 2014;40(5):529-535
• Cited by: 51 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) have demonstrated promising results in the treatment of peritoneal carcinomatosis (PC). The purpose of this study was to assess the impact of this combined procedure on quality of life (QoL).

Materials And Methods: A prospective single centre study of 216 consecutive patients treated with CRS and HIPEC was conducted using the Gastro-Intestinal Quality of Life Index questionnaire (GIQLI), completed preoperatively and at 1, 3, 6 and 12 months.

Results: Questionnaire compliance was 81%, 90%, 89%, 89% and 74% at baseline, 1, 3, 6 and 12 months respectively. QoL was significantly decreased up to 6 months and returned to baseline at 12 months. In multivariate analysis, factors decreasing QoL were origin of PC at 3 months, presence of stoma at 6 months and length of surgery over 270 min and disease recurrence at 12 months.

Conclusions: Despite morbidity associated with CRS and HIPEC, QoL returned to baseline at one year after surgery. This treatment strategy should be considered for the treatment of peritoneal carcinomatosis.

Copyright © 2013 Elsevier Ltd. All rights reserved.

In plain English

This prospective study at Lyon Sud Hospital in France measured quality of life after cytoreductive surgery (removing visible tumour inside the abdomen) combined with heated chemotherapy delivered into the abdomen (HIPEC). Patients had peritoneal carcinomatosis, meaning cancer spread over the abdominal lining. Of 226 consecutive patients treated between January 2007 and February 2011, 10 who died within 45 days of surgery were excluded, leaving 216. Ovarian cancer was the most common origin. Thirteen patients had peritoneal mesothelioma, but the study did not look at asbestos exposure. Patients completed a gastrointestinal quality-of-life questionnaire before surgery and at 1, 3, 6 and 12 months. Serious (grade III or IV) complications occurred in 42%. Quality of life was significantly lower than before surgery at 1, 3 and 6 months and returned to baseline at 12 months. The symptom and feeling subscores still differed significantly from baseline at 12 months. At 12 months, worse quality of life was linked with surgery lasting longer than 270 minutes and with cancer recurrence. The authors concluded that quality of life returned to baseline at one year despite high complication rates.

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: prospective single-centre study of quality of life measured by questionnaire before and after treatment
• Who was studied: 226 consecutive patients treated for peritoneal carcinomatosis at Lyon Sud Hospital, France, January 2007 to February 2011. The 10 who died within 45 days were excluded, leaving 216. The cancer originated in the ovary in 76 (35%) and the colon or rectum in 57 (26%). Peritoneal mesothelioma accounted for 13 patients (printed as 8%).
• Exposure: Not an asbestos exposure study. The 'exposure' was the treatment: cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (cisplatin, mitomycin C, oxaliplatin and irinotecan, alone or combined). Quality of life was assessed with the Gastro-Intestinal Quality of Life Index (GIQLI) before surgery and at 1, 3, 6 and 12 months.
• Main results:
  • Grade III or IV complications occurred in 42% of the 216 patients (91 patients).
  • Overall quality of life (GIQLI total score) was significantly lower than baseline at 1, 3 and 6 months and returned to baseline at 12 months. Average total scores were 102.2 at baseline, 83.0 at 1 month, 90.1 at 3 months, 97.6 at 6 months and 100.1 at 12 months.
  • All subscales except medical treatment differed significantly from baseline at 1 month. For symptoms and feeling, the difference persisted at 12 months.
  • In multivariate analysis, the factors linked with worse quality of life were: origin of the carcinomatosis at 3 months, having a stoma at 6 months, and surgery longer than 270 minutes and disease recurrence at 12 months.
  • At 12 months, the multivariate odds ratio for quality-of-life deterioration (a drop of at least 10% from baseline) was 4.4 (95% CI 1.8 to 10.5) for patients with disease recurrence. For surgery longer than 270 minutes it was 3.0 (95% CI 1.3 to 6.9).
  • At 6 months, the multivariate odds ratio for quality-of-life deterioration was 3 (95% CI 1.5 to 6.2) for patients with a stoma.
• The authors' conclusion: The authors concluded that, although complications after CRS and HIPEC are frequent, quality of life returned to its pre-surgery level at one year after an initial decline. They stated that this treatment should be considered for patients with peritoneal carcinomatosis.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Colon cancer, Ovarian cancer.

Medical terms in this study, explained in our Lexicon: Quality of Life, Cytoreductive Surgery, HIPEC, Multivariate Analysis.

Related studies

• Quality of life in patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: is it worth the risk? — N. Tsilimparis, C. Bockelmann, et al. (2013)
• Peritonectomy and hyperthermic intraperitoneal chemotherapy: cost analysis and sustainability — P.F. Bagnoli, F.C. Cananzi, et al. (2015)
• Postoperative outcomes of laparoscopic vs open cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for treatment of peritoneal surface malignancies — G. Passot, N. Bakrin, et al. (2014)
• The results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1200 patients with peritoneal malignancy — B. Moran, T. Cecil, et al. (2015)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent peritoneal metastases — T.C. Chua, L.E. Quinn, et al. (2013)
• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis: the Danish experience — L.H. Iversen, P.C. Rasmussen, et al. (2013)

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