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. 2023 Jan 27;15(3):788.
doi: 10.3390/cancers15030788.

The Impact of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS-HIPEC) versus Conventional Surgery on Patient-Reported Outcomes: A Comparative Cohort Study between the CAIRO6 Trial and the PROCORE Study

Checca Bakkers  1 , Vincent C J van de Vlasakker  1 , Koen P B Rovers  1 , Robin J Lurvink  1 , Simon W Nienhuijs  1 , Jacobus W A Burger  1 , Geert-Jan M Creemers  2 , Cynthia S Bonhof  3 , Floortje Mols  3   4 , Ignace H J T de Hingh  1   4   5
Affiliations

The Impact of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS-HIPEC) versus Conventional Surgery on Patient-Reported Outcomes: A Comparative Cohort Study between the CAIRO6 Trial and the PROCORE Study

Checca Bakkers et al. Cancers (Basel). .

Abstract

Purpose-To compare patient-reported outcomes (PROs) of patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for colorectal peritoneal metastases to PROs of colorectal cancer (CRC) patients undergoing conventional surgery. Methods-Data were extracted from the CAIRO6 trial (CRS-HIPEC group) and the PROCORE study (conventional surgery group). Nine predefined PROs (derived from the EORTC QLQ-C30 questionnaire) were compared at baseline, in the early postoperative period and one year postoperatively, with correction for treatment with systemic therapy using linear mixed modeling. Results-In total, 331 patients were included: 71 in the CRS-HIPEC group and 260 in the conventional surgery group. All predefined PROs (fatigue, diarrhea, C30 summary score, Global Health Status, physical, role, emotional, cognitive, and social functioning) did not differ significantly between the groups at all three timepoints, and differential effects over time for all PROs did not differ significantly between the groups. Significant worsening of fatigue, C30 summary score, physical and role functioning (both groups), and cognitive and social functioning (conventional surgery group only) was present in the early postoperative period. All scores returned to baseline at one year postoperatively, except for physical and cognitive functioning in the conventional surgery group. Emotional functioning improved postoperatively in both groups compared to baseline. Conclusion-Despite a more extensive procedure with greater risk of morbidity, CRS-HIPEC in patients with colorectal peritoneal metastases did not have a greater negative impact on PROs than conventional surgery in patients with CRC. Further, systemic therapy did not affect these PROs. These findings may facilitate future patient counseling and shared decision making in clinical practice.

Keywords: CRS-HIPEC; colorectal neoplasms; cytoreduction; patient-reported outcome measures; peritoneal neoplasms; quality of life; surgical procedures.

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Conflict of interest statement

De Hingh: An unrestricted research grant from RanD/QP&S and Roche, paid to the institute, unrelated to the submitted work. All other authors did not have any disclosures.

Figures

Figure 1
Figure 1
Patient flowchart. CRS-HIPEC cytoreductive surgery and hyperthermic intraperitoneal chemotherapy; a ± 12 weeks postoperatively; b ± 5 weeks postoperatively.
Figure 2
Figure 2
Comparison of predefined patient-reported outcomes between the CRS-HIPEC group and the conventional surgery group. Continuous lines represent mean PRO scores; dotted lines represent standard deviations of PRO scores. (A) C30 Summary score; (B) Global Health Status; (C) physical functioning; (D) role functioning; (E) emotional functioning; (F) cognitive functioning; (G) social functioning; (H) fatigue; (I) diarrhea.
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