Quality of life in patients with pseudomyxoma peritonei treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy and implications for ERAS-informed rehabilitation.

内容摘要

Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) is the standard of care for pseudomyxoma peritonei (PMP) but is associated with substantial perioperative burden and prolonged recovery. Contemporary data on health-related quality of life (HRQoL) trajectories after CRS + HIPEC remain limited, as does their integration into perioperative and rehabilitation planning. We aimed to characterize short- and mid-term HRQoL changes after CRS + HIPEC in PMP and to identify ERAS-informed rehabilitation priorities based on postoperative symptom and function trajectories. We screened 273 patients from our institutional PMP CRS + HIPEC database and included 111 adults who had adequate EORTC QLQ-C30 data for longitudinal analysis. HRQoL was assessed using the EORTC QLQ-C30 at baseline and 1 week, 1, 3, 6, 9 and 12 months postoperatively. Longitudinal changes were summarized descriptively, and mean differences versus baseline were interpreted using established minimally important difference thresholds (≥10 points). At 1 week postoperatively, physical, role, emotional, cognitive and social functioning and global QoL declined by 22.9, 41.6, 13.3, 19.7, 20.5 and 28.4 points, respectively, all exceeding the threshold for clinically meaningful deterioration. Fatigue, pain, dyspnoea, insomnia, appetite loss and financial difficulties showed peak or near-peak worsening at 1 week, whereas constipation and diarrhea peaked at 3 months. Overall QoL was worst around 1 month postoperatively and then improved steadily; by 12 months, most functional scales and symptoms had returned to or approached baseline (e.g. global QoL -1.1 points vs. preoperative), although mild residual cognitive and bowel disturbances persisted in some patients. CRS + HIPEC for PMP imposes a pronounced but largely transient HRQoL burden, characterized by a sharp early decline, mid-term recovery and near-restoration of baseline QoL within 6-12 months. Our findings support an ERAS-informed rehabilitation framework that prioritizes pain control, respiratory recovery, nutrition, sleep, and psychological support. These elements should be interpreted as clinically informed rehabilitation priorities rather than as a validated intervention package directly derived from this observational dataset. These findings inform preoperative counseling and the timing of follow-up after CRS + HIPEC.