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Impairments in Bowel Function, Social Function and Quality of Life After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy.

细胞减灭术和腹腔热灌注化疗后肠功能、社会功能和生活质量的损害。

  • 影响因子:3.60
  • DOI:10.1245/s10434-019-07385-w
  • 作者列表:"Bayat Z","Taylor EL","Bischof DA","McCart JA","Govindarajan A
  • 发表时间:2020-01-01
Abstract

BACKGROUND:Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) can be associated with decreases in quality of life (QOL). Bowel-related QOL (BR-QOL) after CRS-HIPEC has not been previously studied. The objectives of the current study were to examine the effect of different types of bowel resection during CRS-HIPEC on overall QOL and BR-QOL. METHODS:A prospective cohort study was performed. QOL data were collected using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and CR-29 questionnaires at 3, 6, and 12 months after CRS-HIPEC. Patients were divided into groups that underwent no bowel resection, non-low anterior resection (LAR) bowel resection, LAR, and LAR with stoma. Primary outcomes were global QOL and BR-QOL. RESULTS:Overall, 158 patients were included in this study. Bowel resections were performed in 77% of patients, with 31% undergoing LAR. Global QOL was not significantly different between groups. LAR patients (with and without stoma) had significantly worse BR-QOL, embarrassment, and altered body image, with LAR + stoma patients having the largest impairments in these domains. Trends toward higher levels of impotence and anxiety were also seen in LAR patients. Although global QOL improved over time, impairments in BR-QOL and sexual and social function did not significantly improve over time. CONCLUSIONS:Although global QOL after CRS-HIPEC was not affected by the type of bowel resection, the use of LAR and ostomies was associated with clinically meaningful and persistent impairments in BR-QOL and related functional domains. Generic QOL questionnaires may not adequately capture these domains; however, targeted questionnaires in these patients may help improve QOL after CRS-HIPEC.

摘要

背景: 细胞减灭术和腹腔热灌注化疗 (CRS-HIPEC) 可能与生活质量 (QOL) 下降相关。CRS-HIPEC后肠道相关QOL (BR-QOL) 尚未研究。本研究的目的是检查CRS-HIPEC期间不同类型的肠切除术对总体QOL和BR-QOL的影响。 方法: 进行前瞻性队列研究。使用欧洲癌症研究和治疗组织 (EORTC) QLQ-C30 收集QOL数据,并在CRS-HIPEC术后 3 、 6 和 12 个月进行CR-29 问卷调查。将患者分为未行肠切除术、非低位前切除术 (LAR) 肠切除术、LAR和伴造口的LAR组。主要结局为全球QOL和BR-QOL。 结果: 本研究共纳入 158 例患者。77% 的患者进行了肠切除术,31% 的患者进行了LAR。组间总体QOL无显著差异。LAR患者 (有和没有造口) 的BR-QOL显著更差,尴尬,身体形象改变,lara + 造口患者在这些领域的损伤最大。LAR患者也出现了更高水平的阳痿和焦虑的趋势。虽然随着时间的推移,全球QOL有所改善,但BR-QOL以及性和社会功能的损害并没有随着时间的推移而显著改善。 结论: 虽然CRS-HIPEC术后的全球QOL不受肠切除类型的影响,LAR和ostomies的使用与BR-QOL和相关功能域的临床意义和持续性损伤相关。通用QOL问卷可能无法充分捕获这些领域; 然而,在这些患者中有针对性的问卷可能有助于改善CRS-HIPEC后的QOL。

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影响因子:3.60
发表时间:2020-01-01
DOI:10.1245/s10434-019-07409-5
作者列表:["Letica-Kriegel AS","Leinwand JC","Sonett JR","Gorenstein LA","Taub RN","Chabot JA","Kluger MD"]

METHODS:BACKGROUND:The most common sites of malignant mesothelioma are the pleura and peritoneum, but little is known about the incidence, prognosis, or treatment of patients with disease in both cavities. Previous series suggest that multimodality treatment improves overall survival for pleural or peritoneal disease, but studies typically exclude patients with disease in both cavities. Despite limitations, this investigation is the only study to broadly examine outcomes for patients with malignant mesothelioma in both the pleural and peritoneal cavities. METHODS:This study retrospectively examined 50 patients with both pleural and peritoneal mesothelioma treated with the intent to prolong survival. The primary end point was overall survival from the initial operative intervention. RESULTS:The median overall survival was 33.9 months from the initial intervention. Female gender and intraperitoneal dwell chemotherapy were independent predictors of overall survival. Within 1 year after the initial diagnosis, second-cavity disease was diagnosed in 52% of the patients. The median time to the second-cavity diagnosis for those with a diagnosis 1 year after the initial diagnosis was 30 months. CONCLUSIONS:Well-selected patients with both pleural and peritoneal mesothelioma have a survival benefit over palliative treatment that is comparable with that seen in single-cavity disease. The presence of disease in both cavities is not a contraindication to multimodality treatment aimed at prolonging survival, whether the disease is diagnosed synchronously or metachronously. Patients with an initial diagnosis of single cavity disease are at the highest risk for identification of second-cavity disease within the first year after diagnosis.

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影响因子:3.60
发表时间:2020-01-01
DOI:10.1245/s10434-019-07425-5
作者列表:["Ali YM","Sweeney J","Shen P","Votanopoulos KI","McQuellon R","Duckworth K","Perry KC","Russell G","Levine EA"]

METHODS:INTRODUCTION:Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) is an accepted treatment for peritoneal mesothelioma. In this study, we evaluated QOL after HIPEC for peritoneal mesothelioma. METHODS:This was a prospective study performed after HIPEC for peritoneal mesothelioma between 2002 and 2015. Patients completed QOL surveys, including the Short Form-36 (SF-36), Functional Assessment of Cancer Therapy + Colon (FACT-C), Brief Pain Inventory (BPI), and Center for Epidemiologic Studies Depression Scale (CES-D) preoperatively and at 3, 6, 12, and 24 months postoperatively. RESULTS:Overall, 46 patients underwent HIPEC for peritoneal mesothelioma and completed QOL surveys. Mean age was 52.8 ± 13.8 years and 52% were male. Good preoperative functional status was 70%. Median survival was 3.4 years, and 1, 3, and 5-year survivals were 77.4, 55.2, and 36.5%, respectively. CES-D score decreased at 3 months postoperatively, but increased at 24 months (p = 0.014); SF-36 physical functioning scale decreased at 3 months but returned to baseline at 12 months (p = 0.0045); and the general health scale decreased at 3 months, then improved by 6 months (p = 0.0034). Emotional well-being (p = 0.0051), role limitations due to emotional problems (p = 0.0006), social functioning (p = 0.0022), BPI (p = 0.025), least pain (p = 0.045), and worst pain (p < 0.0001) improved. FACT-C physical well-being decreased at 3 months but returned to baseline at 6 months (p = 0.020), and total FACT-C score improved at 6 months (p = 0.052). CONCLUSION:QOL returned to baseline or improved from baseline between 3 months and 1 year following surgery. Despite the risks associated with this operation, patients may tolerate HIPEC well and have good overall QOL postoperatively.

关键词: 暂无
翻译标题与摘要 下载文献
影响因子:3.60
发表时间:2020-01-01
DOI:10.1245/s10434-019-07385-w
作者列表:["Bayat Z","Taylor EL","Bischof DA","McCart JA","Govindarajan A"]

METHODS:BACKGROUND:Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) can be associated with decreases in quality of life (QOL). Bowel-related QOL (BR-QOL) after CRS-HIPEC has not been previously studied. The objectives of the current study were to examine the effect of different types of bowel resection during CRS-HIPEC on overall QOL and BR-QOL. METHODS:A prospective cohort study was performed. QOL data were collected using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and CR-29 questionnaires at 3, 6, and 12 months after CRS-HIPEC. Patients were divided into groups that underwent no bowel resection, non-low anterior resection (LAR) bowel resection, LAR, and LAR with stoma. Primary outcomes were global QOL and BR-QOL. RESULTS:Overall, 158 patients were included in this study. Bowel resections were performed in 77% of patients, with 31% undergoing LAR. Global QOL was not significantly different between groups. LAR patients (with and without stoma) had significantly worse BR-QOL, embarrassment, and altered body image, with LAR + stoma patients having the largest impairments in these domains. Trends toward higher levels of impotence and anxiety were also seen in LAR patients. Although global QOL improved over time, impairments in BR-QOL and sexual and social function did not significantly improve over time. CONCLUSIONS:Although global QOL after CRS-HIPEC was not affected by the type of bowel resection, the use of LAR and ostomies was associated with clinically meaningful and persistent impairments in BR-QOL and related functional domains. Generic QOL questionnaires may not adequately capture these domains; however, targeted questionnaires in these patients may help improve QOL after CRS-HIPEC.

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腹膜疾病方向

腹膜疾病是一类病因复杂的疾病,包括累及腹膜的各种炎性病变,以结核性腹膜炎多见。由于创伤和炎症导致的粘连,大部分为后天性,表现为腹膜皱襞重叠;还包括原发性和继发性肿瘤,良性原发性肿瘤少见,继发性恶性肿瘤多见,腹膜间皮瘤是唯一原发于腹膜间皮细胞的肿瘤。

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