Quality of Life in Patients after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Is It Worth the Risk? Toxicity and Quality of Life after Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy Quality-of-Life Evaluation After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy Impact of Major Complications on Patients’ Quality of Life After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Methodological index for non‐randomized studies (MINORS): development and validation of a new instrument Quality of life after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: a prospective study of 216 patients. Quality of life after intraperitoneal hyperthermic chemotherapy (IPHC) for peritoneal carcinomatosis. Quality of Life in Peritoneal Carcinomatosis: A Prospective Study in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy for peritoneal surface malignancy: experience with 501 procedures. The Impact of Early Recurrence on Quality of Life after Cytoreduction with HIPEC Impairments in Bowel Function, Social Function and Quality of Life After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
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 Prospect i ve , single-center , nonr and omized cohort study using the European Organization for Research and Treatment of Cancer Quality of Life Question naire . 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 Background The purpose of our study was to determine the toxicity and quality of life for patients with peritoneal metastases after cytoreductive surgery ( CS ) plus hyperthermic intraperitoneal chemotherapy ( HIPC ) .  Methods From 2001 to 2005 , 35 consecutive patients with peritoneal metastases enrolled in a prospect i ve trial approved by the University of Minnesota Institutional Review Board . Their primary cancer sites included the appendix ( 19 patients ) , colon ( 7 ) , mesothelioma ( 3 ) , stomach ( 2 ) , small bowel ( 2 ) , gallbladder ( 1 ) , and unknown ( 1 ) . We performed CS in an effort to remove all or nearly all peritoneal tumor nodules . Using a closed technique , we administered hyperthermic mitomycin C into the peritoneal cavity for 90 min . Before treatment and then at 4-month postoperative intervals , we used the functional assessment of cancer therapy-colon subscale ( FACT-C ) instrument to assess the patients ’ quality of life . Results The median hospital stay was 9 days ; 12 patients were hospitalized at least 30 days or required readmission within 30 days after treatment . The postoperative mortality rate was 0 % ; adverse events occurred in 18 ( 51 % ) patients . As of December 2005 , 20 patients were alive ; 14 had died of progressive disease and 1 of an unrelated cause . The median survival time was 21.4 months . Quality of life measurements , including trial outcome index ( TOI ) , FACT-colon , and FACT-general , returned to baseline 4 months after treatment and were significantly improved at 8 and 12 months . Conclusions Despite early toxicity , CS plus HIPC may prolong the overall survival rate of patients with peritoneal metastases and improve quality of life measurements Background Cytoreductive surgery ( CS ) with hyperthermic intraperitoneal chemotherapy ( HIPEC ) for peritoneal metastases can alleviate symptoms and prolong survival at the expense of morbidity and quality of life ( QoL ) . This study aim ed to monitor QoL and outcomes before and after HIPEC . Methods A prospect i ve QoL trial of patients who underwent HIPEC for peritoneal metastases from 2000 to 2015 was conducted . The patients completed the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) , the Functional Assessment of Cancer Therapy + Colon Subscale ( FACT-C ) , the Brief Pain Inventory , the Center for Epidemiologic Studies Depression scale , and the Eastern Cooperative Oncology Group ( ECOG ) performance status at baseline , then 3 , 6 , 12 , and 24 months after HIPEC . The trial outcome index ( TOI ) was analyzed . Proportional hazards modeled the effect of baseline QoL on survival . Results The 598 patients ( 53.8 % female ) in the study had a mean age of 53.3 years . The overall 1-year survival rate was 76.8 % , and the median survival period was 2.9 years . The findings showed a minor morbidity rate of 29.3 % , a major morbidity rate of 21.7 % , and a 30-day mortality rate of 3.5 % . The BPI ( p < 0.0001 ) and worst pain ( p = 0.004 ) increased at 3 months but returned to baseline at 6 months . After CS + HIPEC , FACT-C emotional well-being , SF-36 mental component score , and emotional health improved ( all p < 0.001 ) . Higher baseline FACT-General ( hazard ratio [ HR ] , 0.92 ; 95 % confidence interval [ CI ] , 0.09–0.96 ) , FACT-C ( HR , 0.73 ; 95 % CI 0.65–0.83 ) , physical well-being ( HR , 0.71 ; 95 % CI 0.64–0.78 ) , TOI ( HR , 0.87 ; 95 % CI 0.84–0.91 ) , and SF-36 vitality ( HR , 0.88 ; 95 % CI 0.83–0.92 ) were associated with improved survival ( all p < 0.001 ) . Higher baseline BPI ( HR , 1.1 ; 95 % CI 1.05–1.14 ; p < 0.0001 ) , worst pain ( HR , 1.06 ; 95 % CI 1.01–1.10 ; p = 0.01 ) , and ECOG ( HR , 1.74 ; 95 % CI 1.50–2.01 ; p < 0.0001 ) were associated with worse survival . Conclusions Although HIPEC is associated with morbidity and detriments to QoL , recovery with good overall QoL typically occurs at or before 6 months . Baseline QoL is associated with morbidity , mortality , and survival after HIPEC 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 review ed data from a prospect ively collected data base 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 vali date d 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 Background : Because of specific method ological difficulties in conducting r and omized trials , surgical research remains dependent predominantly on observational or non‐r and omized studies . Few vali date d instruments are available to determine the method ological quality of such studies either from the reader 's perspective or for the purpose of meta‐ analysis . The aim of the present study was to develop and vali date such an instrument 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 ) . MATERIAL S AND METHODS A prospect i ve single centre study of 216 consecutive patients treated with CRS and HIPEC  was conducted using the Gastro-Intestinal Quality of Life Index question naire ( GIQLI ) , completed preoperatively and at 1 , 3 , 6 and 12 months . RESULTS Question naire 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 AIMS This study assessed the functional status and quality of life ( QOL ) of patients with disseminated peritoneal cancer ( DPC ) before and after cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy ( IPHC ) .  METHODS Patients with confirmed or suspected diagnosis of gastro-intestinal cancer including stomach , pancreas , hepatobiliary and colorectal cancer with peritoneal implants were enrolled in the study . Sixty-four patients completed the Functional Assessment of Cancer Therapy-Colon ( FACT-C ) scale and several other instruments at baseline . Forty-eight , 40 , 39 and 31 patients were assessed at approximately 2 weeks post-surgery , and 3 , 6 and 12 months respectively . RESULTS There was a significant overall effect on the physical ( P=0.0025 ) , emotional ( P<0.0001 ) and functional well-being ( P=0.0044 ) subscales and the FACT-C ( P=0.0076 ) . Physical and functional well-being scores decreased at post-surgery follow-up and increased relative to baseline at 3 , 6 and 12 months . Nineteen per cent , 46 % , 59 % and 74 % of patients resumed greater than 50 % of their normal activities post-operatively at 3 , 6 and 12 months respectively . A percentage of patients reported depressive symptoms : baseline ( 28 % ) , post-operatively ( 33 % ) , 3 months ( 23 % ) , 6 months ( 21 % ) and 12 months ( 29 % ) . CONCLUSIONS Cytoreductive surgery followed by IPHC was well tolerated . Most patients returned to baseline or better levels of functioning within 3 months post-treatment Background / Aims : Cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion ( HIPEC ) can improve survival in selected patients with peritoneal carcinomatosis , but bear a significant risk of perioperative morbidity . The aim of this study was to prospect ively evaluate the quality of life ( QoL ) following cytoreduction and HIPEC . Methods : In this study including 40 patients ( 65 % females ) with different primary tumors , the EORTC QLQ-C30 question naire was applied prior to CS and HIPEC as well as 3 , 9 , and 18 months postoperatively . Results : Global health status was not impaired significantly following HIPEC .  Scales and symptom scores that deteriorated 3 months postoperatively ( p < 0.05 ) , that is , physical , role , and social functions as well as fatigue , pain , dyspnea , insomnia , and diarrhea , all returned to preoperative values within 9 months . Conclusions : Following cytoreductive surgery and HIPEC , QoL returns to preoperative levels within 9 months . Selected patients that are likely to benefit oncologically from HIPEC should not be denied this option for fear of reduced postoperative QoL. i 2014 S. Karger AG , PURPOSE To confirm the findings from uncontrolled studies that aggressive cytoreduction in combination with hyperthermic intraperitoneal chemotherapy ( HIPEC ) is superior to st and ard treatment in patients with peritoneal carcinomatosis of colorectal cancer origin . PATIENTS AND METHODS Between February 1998 and August 2001 , 105 patients were r and omly assigned to receive either st and ard treatment consisting of systemic chemotherapy ( fluorouracil-leucovorin ) with or without palliative surgery , or experimental therapy consisting of aggressive cytoreduction with HIPEC , followed by the same systemic chemotherapy regime . The primary end point was survival . RESULTS After a median follow-up period of 21.6 months , the median survival was 12.6 months in the st and ard therapy arm and 22.3 months in the experimental therapy arm ( log-rank test , P = .032 ) . The treatment-related mortality in the aggressive therapy group was 8 % . Most complications from HIPEC were related to bowel leakage . Subgroup analysis of the HIPEC group showed that patients with 0 to 5 of the 7 regions of the abdominal cavity involved by tumor at the time of the cytoreduction had a significantly better survival than patients with 6 or 7 affected regions ( log-rank test , P < .0001 ) . If the cytoreduction was macroscopically complete ( R-1 ) , the median survival was also significantly better than in patients with limited ( R-2a ) , or extensive residual disease ( R-2b ; log-rank test , P < .0001 ) . CONCLUSION Cytoreduction followed by HIPEC improves survival in patients with peritoneal carcinomatosis of colorectal origin . However , patients with involvement of six or more regions of the abdominal cavity , or grossly incomplete cytoreduction , had still a grave prognosis BACKGROUND Peritoneal dissemination of abdominal malignancy ( PSD ) has a clinical course marked by bowel obstruction and death . We have been using aggressive cytoreductive surgery with intraperitoneal hyperthermic chemotherapy ( IPHC ) to treat PSD . The purpose of this article was to review our experience with IPHC . STUDY DESIGN A prospect i ve data base of patients undergoing IPHC has been maintained since 1991 . Patients were uniformly evaluated and treated . Demographics , performance status , resection status , primary site , and experience quartile were compared with outcomes . Univariate and multivariate analyses were performed . RESULTS A total of 460 patients underwent 501 IPHC procedures . Average age was 53.0 years , and 50.4 % were women . The 30-day mortality rate was 4.8 % , the complication rate was 43 % , and median hospital stay was 9 days . Median followup was 55.4 months , median survival was 22.2 months , and 5-year survival rate was 27.8 % . Factors correlating with improved survival were performance status ( p=0.0001 ) , primary tumor ( p=0.0001 ) , resection status ( p=0.0001 ) , complications ( p=0.002 ) , previous IPHC ( p=0.006 ) , and experience quartile ( p=0.031 ) . On multivariate analysis , primary tumor site , performance status , resection status , and development of complications ( p < 0.001 ) predicted outcomes . CONCLUSIONS Our experience demonstrated that preoperative criteria for better outcomes include primary tumor site and performance status . Completeness of resection and development of postoperative complications are also crucial , and outcomes have improved over time . Cytoreductive surgery and IPHC represent substantial improvements in outcomes compared with historic series and best-available systemic therapy . Longterm survival is possible for selected patients who undergo the procedure Improved oncological outcomes after cytoreductive surgery ( CRS ) with hyperthermic intraperitoneal chemotherapy ( HIPEC ) in highly selected patients have been well documented . The extensive nature of the procedure adversely affects quality of life ( QoL ) . The aim of this study is to longitudinally evaluate QoL following CRS/HIPEC . This is a retrospective review of a prospect ively maintained data base of patients with peritoneal malignancies undergoing CRS/HIPEC .  Clinicopathological data , oncologic outcomes , and QoL were analyzed preoperatively and post-operatively at 2 weeks , and 1 , 3 , 6 , and 12 months . The Functional Assessment of Cancer Therapy-Colorectal instrument was used to determine changes in QoL after CRS/HIPEC and the impact of early recurrence ( < 12 months ) on QoL. Thirty-six patients underwent CRS/HIPEC over 36 months . The median peritoneal cancer index score was 18 and the completeness of cytoreduction-0/1 rate was 97.2 per cent . Postoperative major morbidity was 16.7 per cent with one perioperative death . Disease-free survival was 12.6 months in patients with high- grade tumors versus 31.0 months in those with low- grade tumors ( P = 0.03 ) . QoL decreased postoperatively and improved to baseline in six months . Patients with early recurrence had a decrease in global QoL compared with preoperative QoL at 6 ( P < 0.03 ) and 12 months ( P < 0.05 ) . This correlation was not found in patients who had not recurred . Patients who undergo CRS/HIPEC have a decrease in QoL that plateaus in 3 to 6 months . Early recurrence adversely impacts QoL at 6 and 12 months . This study emphasizes the importance of patient selection for CRS/HIPEC . The expected QoL trajectory in patients at risk for early recurrence must be carefully weighed against the potential oncological benefit of CRS/HIPEC Background Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy ( CRS-HIPEC ) can be associated with decreases in quality of life ( QOL ) . Bowel-related QOL ( BR-QOL ) after CRS-HIPEC has not been previously studied . The objectives of the current study were to examine the effect of different types of bowel resection during CRS-HIPEC on overall QOL and BR-QOL . Methods A prospect i ve cohort study was performed . QOL data were collected using the European Organisation for Research and Treatment of Cancer ( EORTC ) QLQ-C30 and CR-29 question naires at 3 , 6 , and 12 months after  CRS-HIPEC .  Patients were divided into groups that underwent no bowel resection , non-low anterior resection ( LAR ) bowel resection , LAR , and LAR with stoma . Primary outcomes were global QOL and BR-QOL . Results Overall , 158 patients were included in this study . Bowel resections were performed in 77 % of patients , with 31 % undergoing LAR . Global QOL was not significantly different between groups . LAR patients ( with and without stoma ) had significantly worse BR-QOL , embarrassment , and altered body image , with LAR + stoma patients having the largest impairments in these domains . Trends toward higher levels of impotence and anxiety were also seen in LAR patients . Although global QOL improved over time , impairments in BR-QOL and sexual and social function did not significantly improve over time . Conclusions Although global QOL after CRS-HIPEC was not affected by the type of bowel resection , the use of LAR and ostomies was associated with clinical ly meaningful and persistent impairments in BR-QOL and related functional domains . Generic QOL question naires may not adequately capture these domains ; however , targeted question naires in these patients may help improve QOL after CRS-HIPEC
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 .