Skip to main content

Advertisement

SpringerLink
Log in

Long-term Quality of Life After Cytoreductive Surgery and Heated Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei: A Prospective Longitudinal Study

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are an established treatment for pseudomyxoma peritonei (PMP), but it is a major surgical procedure and may be associated with long-term morbidity. To date, health-related quality-of-life (HRQL) data among survivors are lacking.

Methods

A two-period qualitative study investigated patients undergoing CRS-HIPEC for PMP at a national peritoneal tumor center between 2003 and 2011. First, the European Organization for Research and Treatment (EORTC)-QLQ C30 HRQL questionnaire was used longitudinally preoperatively and at postoperative months 3, 6, 9, 12, 18, and 24, then yearly thereafter. Second, it was updated in 2016 as a cross-sectional study. Both studies were compared with age- and sex-matched reference populations (one-way t tests).

Results

A total of 553 longitudinal HRQL questionnaires were completed for 137 patients, truncated at 60 months. In the 2016 update, 85 responses were received from 103 survivors (mean follow-up period, 8.11 years). Patients’ physical, role, and social function scores were impaired until 12 months postoperatively, after which the scores did not differ significantly from those of with reference populations. Similarly, fatigue, appetite loss, insomnia, and financial difficulties worsened significantly compared with reference populations in the first 12-months and then normalized. In contrast, impaired cognitive function (82.3 vs 88.5; P = 0.017), constipation (13.7 vs 7.3; P = 0.032), and diarrheal symptoms (15.1 vs 4.9; P = 0.0006) persisted through both periods. Global health scores did not differ significantly from those of the reference population.

Conclusions

Beyond 12 months postoperatively, CRS-HIPEC for PMP is associated with a good quality of life except for some cognitive functional impairment and bowel disturbances.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Carr NJ, Cecil TD, Mohamed F, et al. A consensus for classification and pathologic reporting of pseudomyxoma peritonei and associated appendiceal neoplasia: the results of the peritoneal surface oncology group international (PSOGI) modified delphi process. Am J Surg Pathol. 2016;40:14–26.

    Article  PubMed  Google Scholar 

  2. Sugarbaker PH. New standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome? Lancet Oncol. 2006;7:69–76.

    Article  PubMed  Google Scholar 

  3. Seretis C, Youssef H. Quality of life after cytoreductive surgery and intraoperative hyperthermic intraperitoneal chemotherapy for peritoneal surface malignancies: a systematic review. Eur J Surg Oncol. 2014;40:1605–13.

    Article  CAS  PubMed  Google Scholar 

  4. Shan LL, Saxena A, Shan BL, Morris DL. Quality of life after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis: a systematic review and meta-analysis. Surg Oncol. 2014;23:199–210.

    Article  PubMed  Google Scholar 

  5. Dodson RM, McQuellon RP, Mogal HD, et al. Quality-of-life evaluation after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2016;23(Suppl 5):772–83.

    Article  PubMed  PubMed Central  Google Scholar 

  6. McQuellon RP, Loggie BW, Fleming RA, Russell GB, Lehman AB, Rambo TD. Quality of life after intraperitoneal hyperthermic chemotherapy (IPHC) for peritoneal carcinomatosis. Eur J Surg Oncol. 2001;27:65–73.

    Article  CAS  PubMed  Google Scholar 

  7. Knutsen A, Sielaff TD, Greeno E, Tuttle TM. Staged laparoscopic infusion of hyperthermic intraperitoneal chemotherapy after cytoreductive surgery. J Gastrointest Surg. 2006;10:1038–43.

    Article  PubMed  Google Scholar 

  8. Tuttle TM, Zhang Y, Greeno E, Knutsen A. Toxicity and quality of life after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2006;13:1627–32.

    Article  PubMed  Google Scholar 

  9. Lim SJ, Cormier JN, Feig BW, et al. Toxicity and outcomes associated with surgical cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with sarcomatosis. Ann Surg Oncol. 2007;14:2309–18.

    Article  PubMed  Google Scholar 

  10. Jess P, Iversen LH, Nielsen MB, Hansen F, Laurberg S, Rasmussen PC. Quality of life after cytoreductive surgery plus early intraperitoneal postoperative chemotherapy for pseudomyxoma peritonei: a prospective study. Dis Colon Rectum. 2008;51:868–74.

    Article  PubMed  Google Scholar 

  11. Macri A, Maugeri I, Trimarchi G, et al. Evaluation of quality of life of patients submitted to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinosis of gastrointestinal and ovarian origin and identification of factors influencing outcome. In Vivo. 2009;23:147–50.

    CAS  PubMed  Google Scholar 

  12. Zenasni F, Botella M, Elias D, et al. The long-term impact of hyperthermic intraperitoneal chemotherapy on survivors treated for peritoneal carcinomatosis: a cross-sectional study. Support Care Cancer. 2009;17:1255–61.

    Article  PubMed  Google Scholar 

  13. Alves S, Mohamed F, Yadegarfar G, Youssef H, Moran BJ. Prospective longitudinal study of quality of life following cytoreductive surgery and intraperitoneal chemotherapy for pseudomyxoma peritonei. Eur J Surg Oncol. 2010;36:1156–61.

    Article  CAS  PubMed  Google Scholar 

  14. Duckworth KE, McQuellon RP, Russell GB, et al. Patient-rated outcomes and survivorship following cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CS + HIPEC). J Surg Oncol. 2012;106:376–80.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Schmidt U, Dahlke MH, Klempnauer J, Schlitt HJ, Piso P. Perioperative morbidity and quality of life in long-term survivors following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Eur J Surg Oncol. 2005;31:53–8.

    Article  CAS  PubMed  Google Scholar 

  16. Hill AR, McQuellon RP, Russell GB, Shen P, Stewart JHT, Levine EA. Survival and quality of life following cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis of colonic origin. Ann Surg Oncol. 2011;18:3673–9.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Tsilimparis N, Bockelmann C, Raue W, et al. Quality of life in patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: is it worth the risk? Ann Surg Oncol. 2013;20:226–32.

    Article  PubMed  Google Scholar 

  18. Kirby R, Liauw W, Zhao J, Morris D. Quality of life study following cytoreductive surgery and intraperitoneal chemotherapy for pseudomyxoma peritonei including redo procedures. Int J Surg Oncol. 2013;2013:461041.

    PubMed  PubMed Central  Google Scholar 

  19. McQuellon RP, Loggie BW, Lehman AB, et al. Long-term survivorship and quality of life after cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis. Ann Surg Oncol. 2003;10:155–62.

    Article  PubMed  Google Scholar 

  20. Chua TC, Moran BJ, Sugarbaker PH, et al. Early- and long-term outcome data of patients with pseudomyxoma peritonei from appendiceal origin treated by a strategy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Clin Oncol. 2012;30:2449–56.

    Article  PubMed  Google Scholar 

  21. Ansari N, Chandrakumaran K, Dayal S, Mohamed F, Cecil TD, Moran BJ. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1000 patients with perforated appendiceal epithelial tumours. Eur J Surg Oncol. 2016;42:1035–41.

    Article  CAS  PubMed  Google Scholar 

  22. Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85:365–76.

    Article  CAS  PubMed  Google Scholar 

  23. Fish R, Selvasekar C, Crichton P, et al. Risk-reducing laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for low-grade appendiceal mucinous neoplasm: early outcomes and technique. Surg Endosc. 2014;28:341–5.

    Article  PubMed  Google Scholar 

  24. Rout S, Renehan AG, Parkinson MF, et al. Treatments and outcomes of peritoneal surface tumors through a centralized national service (United kingdom). Dis Colon Rectum. 2009;52:1705–14.

    Article  CAS  PubMed  Google Scholar 

  25. Sugarbaker PH, Zhu BW, Sese GB, Shmookler B. Peritoneal carcinomatosis from appendiceal cancer: results in 69 patients treated by cytoreductive surgery and intraperitoneal chemotherapy. Dis Colon Rectum. 1993;36:323–9.

    Article  CAS  PubMed  Google Scholar 

  26. Trotti A, Colevas AD, Setser A, et al. CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol. 2003;13:176–81.

    Article  PubMed  Google Scholar 

  27. Fayers PM, Aaronson NK, Bjordal K, et al. The EORTC QLQ-C30 Scoring Manual. 3rd ed. European Organisation for Research and Treatment of Cancer, Brussels, 2001.

    Google Scholar 

  28. Hinz A, Singer S, Brahler E. European reference values for the quality of life questionnaire EORTC QLQ-C30: results of a German investigation and a summarizing analysis of six European general population normative studies. Acta Oncol. 2014;53:958–65.

    Article  PubMed  Google Scholar 

  29. McQuellon RP, Danhauer SC, Russell GB, et al. Monitoring health outcomes following cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis. Ann Surg Oncol. 2007;14:1105–13.

    Article  PubMed  Google Scholar 

  30. McQuellon RP, Russell GB, Shen P, Stewart JHt, Saunders W, Levine EA. Survival and health outcomes after cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for disseminated peritoneal cancer of appendiceal origin. Ann Surg Oncol. 2008;15:125–33.

    Article  PubMed  Google Scholar 

  31. Chia CS, Tan GH, Lim C, Soo KC, Teo MC. Prospective quality of life study for colorectal cancer patients with peritoneal carcinomatosis undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2016;23:2905–13.

    Article  PubMed  Google Scholar 

  32. Scott NW, Fayers PM, Aaronson NK, et al. EORTC QLQ-C30 reference values. European Organisation for Research and Treatment of Cancer, Brussels, 2008.

    Google Scholar 

  33. Hjermstad MJ, Fayers PM, Bjordal K, Kaasa S. Health-related quality of life in the general Norwegian population assessed by the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire: the QLQ-C30 (+3). J Clin Oncol. 1998;16:1188–96.

    Article  CAS  PubMed  Google Scholar 

  34. Schwarz R, Hinz A. Reference data for the quality-of-life questionnaire EORTC QLQ-C30 in the general German population. Eur J Cancer. 2001;37:1345–51.

    Article  CAS  PubMed  Google Scholar 

  35. Skevington SM, Lotfy M, O’Connell KA, Group W. The World Health Organization’s WHOQOL-BREF quality-of-life assessment: psychometric properties and results of the international field trial: a report from the WHOQOL group. Qual Life Res. 2004;13:299–310.

    Article  CAS  PubMed  Google Scholar 

  36. Ludemann R, Watson DI, Jamieson GG. Influence of follow-up methodology and completeness on apparent clinical outcome of fundoplication. Am J Surg. 2003;186:143–7.

    Article  PubMed  Google Scholar 

  37. Nakash RA, Hutton JL, Jorstad-Stein EC, Gates S, Lamb SE. Maximising response to postal questionnaires: a systematic review of randomised trials in health research. BMC Med Res Methodol. 2006;6:5.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

The study was funded by charity funds from the PMP Research Fund and the Christie Charitable Fund. The authors acknowledge Siobhan Duane for secretarial assistance with this project.

Disclosure

There are no conflicts of interest.

Author information

Authors and Affiliations

  1. Colorectal and Peritoneal Oncology Centre, The Christie Hospital NHS Foundation Trust, Manchester, UK

    Adam T. Stearns MA, DPhil, FRCS, Lee Malcomson BSc, Grant Punnett MSc, Haytham Abudeeb FRCS, Omer Aziz PhD, FRCS, Chelliah R. Selvasekar MD, FRCS, Paul E. Fulford FRCS, Malcolm S. Wilson MD, FRCS, Andrew G. Renehan PhD, FRCS & Sarah T. O’Dwyer MD, FRCS

  2. Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK

    Lee Malcomson BSc, Omer Aziz PhD, FRCS, Andrew G. Renehan PhD, FRCS & Sarah T. O’Dwyer MD, FRCS

  3. Department of General Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, UK

    Adam T. Stearns MA, DPhil, FRCS

Authors
  1. Adam T. Stearns MA, DPhil, FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lee Malcomson BSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Grant Punnett MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Haytham Abudeeb FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Omer Aziz PhD, FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chelliah R. Selvasekar MD, FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Paul E. Fulford FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Malcolm S. Wilson MD, FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Andrew G. Renehan PhD, FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Sarah T. O’Dwyer MD, FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adam T. Stearns MA, DPhil, FRCS.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stearns, A.T., Malcomson, L., Punnett, G. et al. Long-term Quality of Life After Cytoreductive Surgery and Heated Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei: A Prospective Longitudinal Study. Ann Surg Oncol 25, 965–973 (2018). https://doi.org/10.1245/s10434-017-6326-0

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-017-6326-0

Keywords

Search

Navigation