Does Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Lead to Worse Quality of Life?

Background: Cytoreductive surgery with Hyperthermic Intraperitoneal Chemotherapy (CRS+HIPEC) is being utilized more frequently to treat peritoneal surface malignancies. However, extensive surgery is associated with significant postoperative morbidity and prolonged recovery. This study evaluates whether patients undergoing CRS+HIPEC experience decreased short-term quality of life (QoL). Methods: Patients scheduled for CRS+HIPEC for peritoneal malignancy were prospectively enrolled and completed the 26 item World Health Organization (WHOQOL-BREF) QoL questionnaire preoperatively and 3 months postoperatively. Questions assessed physical, psychological, social and environmental functioning. Patient demographics, treatment characteristics and morbidity were analyzed in conjunction with QoL scores. Results: 28 patients consented to participate. Of these, 17 patients completed both the preoperative and postoperative questionnaires, and 14 or 82% of these underwent CRS+HIPEC. Median age of participants was 53 years, and most was Caucasian, non-Hispanic, and privately insured. Most patients had an ECOG status of 1. 53% of patients had an appendiceal primary tumor and 24% had comorbidities. 53% experienced R0 resection. Median ICU and hospital stay were 4 and 9 days respectively. Postoperative complications occurred in 35%, most frequently pleural effusion (18%), fistula formation (12%) and postoperative ileus (12%). Physical health scores increased postoperatively whereas psychological scores increased slightly. Increased time between questionnaires was associated with improved physical well-being scores and R2 resection with worse scores. Conclusions: Despite significant morbidity, patients who undergo CRS+HIPEC maintain QoL and satisfaction with their health. Patients may be counseled that in addition to potential prolongation of survival, postoperative QoL is generally preserved or improved after CRS+HIPEC.