The influence of postoperative morbidity on medium to long-term quality of life trajectories following cytoreductive surgery for peritoneal malignancy – A prospective cohort study

Abstract

PurposeCytoreductive surgery (CRS) improves survival of selected patients with peritoneal malignancy. However, postoperative morbidity rates remain high. The aim of this study was to determine the impact of postoperative morbidity on the quality of life (QOL) trajectories of patients undergoing CRS. MethodsThis prospective cohort study included consecutive patients undergoing CRS for peritoneal malignancy between April 2017 and March 2023. QOL measures were collected at baseline, pre-discharge, 3, 6, 12, 18 and 24 months postoperatively using the short-form 36 (SF-36v2) survey. Postoperative in-hospital complications were defined according to the Clavien-Dindo Classification. Differences in QOL trajectories for patients with, and without, postoperative complications, length of stay (short versus long) were determined using mixed effects analyses. ResultsA total of 368 patients were included. Mean age was 55 years and 56.2% were female. The main indications for CRS were colorectal peritoneal metastases (46.9%) and appendix adenocarcinoma (23.9%). Overall, QOL decreased sharply from baseline to pre-hospital discharge, returning to baseline 6 to 12 months post-surgery. Severity of postoperative complication and longer length of stay were the main factors negatively impacting physical component trajectories. Postoperative complication, severity of complication and longer length of stay negatively influenced mental component scores, mostly at pre-discharge. ConclusionsQOL following CRS returns to baseline levels within 6 to 12 months. Postoperative morbidity was associated with poorer health related QOL trajectories. Interventions aimed at reducing postoperative morbidity and targeted support may enhance long-term QOL outcomes.