Per Jess, Dr.Med.Sci.1 _ Lene H. Iversen, Ph.D.2 _ Mette B. Nielsen, M.D.2 et al.
1 Department of Surgery, Nordsjaellands Hospital Hillerod, Hillerod, Denmark
2 Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark
3 Department of Oncology, Aarhus University Hospital, Aarhus, Denmark

Diseases of the Colon and Rectum, Vol. 51, Issue: 6, June 2008. pp.868 - 874.

Link to abstract

Pseudomyxoma Peritonei is a rare cancer that spreads in the abdominal and pelvic region by a burst of tumor cells usually from the appendix but also from the ovaries in women. Although it is a rare cancer, it is mostly fatal because of the mucus accumulation and the damage it causes to the internal organs. There are three main pathological classifications of this cancer: peritoneal mucinous carcinomatosis (PMCA), disseminated peritoneal adenomucinosis (DPAM), and a hybrid form intermediate between PMCA and DPAM, PMCA-I.

Earlier treatment of PMP was based on serial debulking, which entailed the surgical removal of tumor cells and the removal of mucin from the abdominal cavity. It was more of a palliative treatment for reoccurring symptoms with only a small percentage of people surviving after 5yrs. These days, modern medicine uses cytoreductive surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). CRS involves a number of surgical procedures which may include the removal of the peritoneum, omentum, spleen, under surface of the diaphragm, gall bladder, uterus, ovaries, appendix, liver capsul, gutters, colon (or parts of it), Douglas pouch and stomach. HIPEC is a chemotherapeutic solution administered directly to the abdominal cavity at a high temperature (usually between 42-44C) to kill microscopic tumor cells left behind after surgery. Combining CRS and HIPEC now boasts survival rates from 59% to 96% at 5yrs and even 70% at 20years with favorable pathology. In some cases, the local chemotherapy needs to be administered for a number of times after the completion of the surgical procedure, this is called early post operative intraperitoneal chemotherapy (EPIC). Though long-term studies on the quality of life after CRS and HIPEC show good results (63% report good quality of life after 3-8 years), no studies have been conducted for the quality of life of those patients receiving EPIC.

In order to study the effect of CRS and EPIC on the quality of life , 21 patients filled out the QOL questionnaire preoperatively and postoperatively. The patients also filled out the questionnaires during their follow up at 6, 12, 18, and 24months. All patients received CRS and EPIC which included cycles with 5-Fluororacil (800 mg) and calcium folinate (80 mg) starting 2 days after surgery with an interval of 14 days until 3 months after surgery. Patients were grouped according their pathology into DPAM (n=7),

The areas measured by this study included Physical Function, Role Physical, Bodily Pain, General Health Perceptions, Vitality, Social Function, Role Emotional, and Mental Health. Raw scores were transformed to 0 to 100 scales, with 0 and 100 assigned to the lowest and highest possible values respectively. Higher transformed scores indicate better health.

The results were optimistic none of the patients died within 30 days, 70% of the patients had one or more complication but all recovered and 14% had an asymptomatic recurrence within two years. The lowest values for QOL was lowest in the physical function section at the 3month follow up which can be attributed to the short amount of time between treatment and follow. The values in all areas gradually increased with every follow up from the 3rd month all through the 24th month. Despite the high morbidity, 63% of the 21 patients reported good quality of life.

It seems that although cytoreductive surgery plus HIPEC is an extensive treatment with a high morbidity, its impact on QOL is relatively little and only temporary.