title: Quality of life after cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy for peritoneal carcinomatosis: A systematic review and meta-analysis.
abstract: OBJECTIVE
  To review the effect of cytoreductive surgery (CRS) and hyperthermic intra-peritoneal chemotherapy (HIPEC) on health-related quality of life (HRQOL) in patients with peritoneal carcinomatosis.
  
  
  BACKGROUND
  CRS and HIPEC is increasingly performed with curative intent for peritoneal carcinomatosis. Significant morbidity rates are reported in the context of limited life-expectancy, necessitating accurate post-operative HRQOL outcome data.
  
  
  METHODS
  A systematic review of clinical studies published after January 2000 was performed using strict eligibility criteria. Key outcomes measures were post-operative HRQOL compared to pre-operative levels and reference populations. Quality appraisal and data tabulation were performed using pre-determined forms. Data were synthesised by narrative review and random-effects meta-analysis. Tau2 and I2 values and Funnel plots were analysed for consistency and bias.
  
  
  RESULTS
  15 studies (1583 patients) were included. HRQOL declines at the 3-4 month time-point before becoming similar or better compared to pre-operative levels at 1 year. The pooled-effects of combined post-operative functional assessment of cancer therapy and European organisation for research and treatment quality of life questionnaire scores were significantly improved from baseline on overall health status (p=0.001) and emotional health (p=0.001). Physical health (p=0.83), social health (p=0.48) and functional health (p=0.24) remain similar. HRQOL after 1 year is less clear, but benefits may persist up to 5 years especially on overall and physical health domains. Evidence is conflicted and inconclusive on HRQOL compared to reference populations. Levels of consistency and bias were acceptable.
  
  
  CONCLUSIONS
  CRS and HIPEC for peritoneal carcinomatosis can confer small to medium benefits for HRQOL. These results should be interpreted with in caution due to the small studies and absence of more randomised controlled trials.
authors.affiliation: Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia.
authors.forename: Leonard L
authors.initials: LL
authors.lastname: Shan
authors.affiliation: UNSW Department of Surgery, St George Hospital, Gray Street, Kogarah, New South Wales, Australia. Electronic address: akshat16187@gmail.com.
authors.forename: Akshat
authors.initials: A
authors.lastname: Saxena
authors.affiliation: Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
authors.forename: Bernard L
authors.initials: BL
authors.lastname: Shan
authors.affiliation: UNSW Department of Surgery, St George Hospital, Gray Street, Kogarah, New South Wales, Australia.
authors.forename: David L
authors.initials: DL
authors.lastname: Morris
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002277:Carcinoma / Q000628:therapy*; D065426:Cytoreduction Surgical Procedures; D004644:Emotions; D006304:Health Status; D006801:Humans; D006979:Hyperthermia, Induced; D007263:Infusions, Parenteral; D010534:Peritoneal Neoplasms / Q000628:therapy*; D011788:Quality of Life; D011795:Surveys and Questionnaires
chemical_list: D000970:Antineoplastic Agents
keywords: Cytoreductive; Hyperthermic; Intraperitoneal; Peritoneal carcinomatosis; Quality of life; Survival