The impact of hyperthermic intraperitoneal chemotherapy and cytoreductive surgery on clinical outcomes and quality of life of patients with peritoneal carcinomatosis

Abstract

Aim of the study To investigate the impact of hyperthermic intraperitoneal chemotherapy (HIPEC) on the clinical and oncological outcomes and quality of life (QOL) of patients with peritoneal carcinomatosis (PC). Material and methods The study involved 304 patients with PC of different origin, who were divided into 2 groups: Group I – cytoreductive surgery (CRS) + adjuvant chemotherapy (ACT) – 247 patients; Group II – CRS + HIPEC + ACT – 57 patients. Intraoperative characteristics and postoperative complications were compared. Patients’ QOL was assessed at all phases of treatment using the international scales the Short Form-36 Health Survey (SF-36) and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for Breast Cancer Core 30 (EORTC QLQ-C30). Results No statistically significant differences were observed between the 2 groups comparing the average blood loss and the total rate of postoperative complications, although the rates of hyperthermia and acute renal failure in the early postoperative period were higher in the HIPEC group. The use of HIPEC significantly contributed to the worse restoration of intestinal function in the postoperative period and to prolonged hospital stay. Assessment of the QOL of patients in Group II using SF-36 showed no significant difference between the physical and psychological components of health compared with the control group. The analysis of EORTC data showed a significant deterioration in the QOL of patients in Group II due to increased scales of pain, nausea and vomiting, and constipation in the early postoperative period. No difference in QOL was observed in the subsequent phases of treatment and after its completion. Overall survival and disease-free survival of patients with ovarian cancer who underwent HIPEC were significantly better compared with CRS + ACT alone. Conclusions The proposed HIPEC technique has demonstrated its clinical safety in the treatment of PC, no long-term negative impact on the QOL of patients, and better oncological results for ovarian cancer.

Adoption of cytoreductive surgery in the management of peritoneal malignancies—Global trends

“…While many of the studies on CRS/HIPEC have been published from institutions in high‐income countries (HIC), there is emerging literature on the successful implementation of peritoneal malignancy programs in low‐ and middle‐income countries (LMIC) 12–14,18,20–22 . The factors that impact the adoption of CRS include access to a multi‐disciplinary team with expertise in PM, the learning curve of surgeons and staff, perioperative support, funding mechanisms, awareness and education about the benefits of CRS, and social barriers.…”