Quality of life in patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: is it worth the risk?

Our plain-English summary of Quality of life in patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: is it worth the risk?, by N. Tsilimparis, C. Bockelmann, W. Raue, et al (Annals of Surgical Oncology, 2013).

The study

• Authors: N. Tsilimparis, C. Bockelmann, W. Raue, C. Menenakos, S. Perez, B. Rau, J. Hartmann
• Journal: Annals of Surgical Oncology
• Published: 2013;20(1):226-32
• Cited by: 51 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: To investigate the course of health-related quality of life (HQL) over time in patients with peritoneal carcinomatosis (PC) after complete cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

Methods: Prospective, single-center, nonrandomized cohort study using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire.

Results: Ninety patients who underwent CRS and HIPEC for PC in our institution were enrolled in the study. Mean age was 56 years (range 27-77 years) (61% female). Primary tumor was colorectal in 21%, ovarian in 19%, pseudomyxoma peritonei in 16%, an appendix tumor in 16%, gastric cancer in 10%, and peritoneal mesothelioma in 13% of cases. Mean peritoneal carcinomatosis index was 22 (range 2-39). Mean global health status score was 69±25 preoperatively and 55±20, 66±22, 66±23, 71±23, and 78±21 at months 1, 6, 12, 24, and 36, respectively. Physical and role function recovered significantly at 6 months and were close to baseline at the 24-month measurement. Emotional function starting from a low baseline recovered to baseline by month 12. Cognitive and social function had slow recovery on follow-up. Fatigue, diarrhea, dyspnea, and sleep disturbance were symptoms persistent at 6-month follow-up, improving later on in survivors.

Conclusions: Survivors after CRS and HIPEC have postoperative quality of life similar to preoperatively, with most of the reduced elements recovering after 6-12 months. We conclude that reduced quality of life of patients after CRS and HIPEC should not be used as an argument to deny surgical therapy to these patients.

In plain English

This prospective study at a Berlin university hospital followed quality of life in 90 patients treated between 2005 and 2010 with cytoreductive surgery plus heated chemotherapy inside the abdomen (HIPEC) for cancer spread across the abdominal lining. Peritoneal mesothelioma was the primary tumor in 13% of cases. Their results were not reported separately, and the article does not discuss asbestos. Patients completed a standard European cancer quality-of-life questionnaire before surgery and at intervals up to 36 months. Responses fell from 83 at baseline to 6 at 36 months, when 22 surviving patients remained on follow-up. Mean global health scores were 69 before surgery, 55 at 1 month, 66 at 6 months and 78 at 36 months. Physical function improved significantly by 6 months but had not returned to baseline at 24 months. Cognitive and social function recovered slowly. Fatigue, diarrhea, breathlessness and sleep problems persisted at 6 months. Surgical complications occurred in 48% of patients. The authors concluded that survivors regained near-baseline quality of life within the first year. They noted that patients staying in follow-up were likely those in better condition.

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-center, nonrandomized cohort study of quality of life after surgery, using the EORTC QLQ-C30 questionnaire
• Who was studied: Of 112 patients who had cytoreductive surgery and HIPEC for peritoneal carcinomatosis at a university hospital in Berlin, Germany (Charité) between 02/2005 and 07/2010, 90 were included. Six were ineligible and 16 refused. Mean age was 56 years (range 27–77) and 61% were female. Primary tumors were colorectal (21%), ovarian (19%), pseudomyxoma peritonei (16%), appendix (16%), gastric (10%) and peritoneal mesothelioma (13%).
• Exposure: Not an asbestos exposure study. The exposure examined was the treatment: complete cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC). Patients who had only one of the two procedures, or exploration without resection, were excluded.
• Main results:
  • Peritoneal mesothelioma was the primary tumor in 13% of the 90 patients. No separate quality-of-life results were given for this group.
  • Mean global health status score (0–100, higher is better) for the whole group was 69 (standard deviation 25) before surgery, then 55, 66, 66, 71 and 78 at months 1, 6, 12, 24 and 36. The numbers answering were 83 at baseline, then 53, 42, 32, 17 and 6.
  • Among surviving patients still on follow-up, the share who answered was 53 of 88 at 1 month, 42 of 83 at 6 months, 32 of 79 at 12 months, 17 of 42 at 24 months, and 6 of 22 at 36 months.
  • Global health status at 6 months was close to baseline (paired test baseline to 6 months, P = 0.32). Physical function recovered significantly at 6 months (P = 0.01) but did not quite reach baseline at 24 months.
  • Emotional function, which started from a low baseline, recovered to baseline by month 12. Cognitive and social function fell by 15–20 points at 1 month and recovered very slowly.
  • Fatigue, diarrhea, dyspnea (breathlessness) and sleep disturbance did not significantly improve to baseline at 6 months. For most of these symptoms, survivors showed major improvement at 24–36 months.
  • Surgical complications occurred in 43 of the 90 patients (48%). Twenty patients (22%) needed surgical revision within 30 days.
  • Estimated pooled overall survival for all tumor types was 88% at 1 year, 78% at 2 years and 70% at 3 years.
• The authors' conclusion: The authors concluded that survivors of cytoreductive surgery and HIPEC reach a quality of life close to their baseline within the first postoperative year. In their view, reduced quality of life should not be a reason to refuse treatment to patients with peritoneal carcinomatosis.
• Limitations the authors state:
  • Results were pooled across patients with different tumor types and different natural histories of disease.
  • The 16 patients who declined to take part had longer disease histories and possibly worse baseline quality of life and prognosis.
  • Patients who kept returning questionnaires were likely those in fairly good condition, which biases a long-term study like this one.
  • Comparison with other studies is limited because patient groups, countries, questionnaires and study designs differ.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Quality of Life, Cytoreductive Surgery, HIPEC, Cohort Study, Stomach Cancer, Peritoneal Mesothelioma, Dyspnea.

Related studies

• Quality of life after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: a prospective study of 216 patients — G. Passot, N. Bakrin, et al. (2014)
• Impact of Major Complications on Patients' Quality of Life After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy — T.D. Hamilton, E.L. Taylor, et al. (2016)
• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis: the Danish experience — L.H. Iversen, P.C. Rasmussen, et al. (2013)
• The results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1200 patients with peritoneal malignancy — B. Moran, T. Cecil, et al. (2015)
• Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy (HIPEC) by Minimally Invasive Approach, an Initial Experience — A. Arjona-Sanchez, S. Rufian-Peña, et al. (2018)
• Peritonectomy and hyperthermic intraperitoneal chemotherapy: cost analysis and sustainability — P.F. Bagnoli, F.C. Cananzi, et al. (2015)

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