QUALITY OF LIFE OF PATIENTS AFTER CYTOREDUCTIVE SURGERY AND HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY: A SYSTEMATIC REVIEW

Cytoreductive Surgery (CRS) combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is an advanced therapeutic approach for treating peritoneal surface malignancies. Despite its efficacy in improving survival rates, the procedure's complexity and potential adverse effects can significantly impact patients' Quality of Life (QoL). This systematic review aims to evaluate the impact of CRS and HIPEC on patients' QoL, focusing on both short-term and long-term outcomes. A systematic review was conducted following the PRISMA guidelines and PICO method. Studies were identified through PubMed, Scopus, ScienceDirect, Cochrane Library, and Google Scholar using keywords such as "quality of life," "cytoreductive surgery," and "hyperthermic intraperitoneal chemotherapy." Inclusion criteria encompassed studies published after 2014 that utilized validated QoL assessment tools. A total of 29 studies met the inclusion criteria and were analyzed for QoL outcomes and factors influencing QoL. The review revealed that QoL typically declines in the immediate postoperative period (first 3 months) but gradually improves, reaching or exceeding baseline levels by 6–12 months post-surgery. Commonly used QoL assessment tools included the EORTC QLQ-C30, SF-36, and FACT-C. Factors influencing QoL included patient age, gender, baseline health status, completeness of cytoreduction (CC score), and postoperative complications. Chemotherapeutic agents used during HIPEC, such as mitomycin C, cisplatin, and oxaliplatin, also impacted QoL, with cisplatin and oxaliplatin showing better QoL outcomes in ovarian and colorectal cancer patients, respectively. CRS combined with HIPEC is a viable treatment option for selected patients with peritoneal surface malignancies, offering not only survival benefits but also the potential to preserve or improve long-term QoL. However, the immediate postoperative period is critical, with patients experiencing significant physical and emotional challenges. Future research should focus on optimizing perioperative care, developing disease-specific QoL assessment tools, and addressing patients' psychological and social needs to further enhance their quality of life. Additionally, policies that ensure equitable access to these treatments, particularly in countries like Greece where HIPEC is not state-funded, are essential to improving patient outcomes.