ExWell Medical, Dublin, Ireland.
School of Health and Human Performance, Dublin City University, Dublin, Ireland.
PLoS One. 2020 Dec 9;15(12):e0242816. doi: 10.1371/journal.pone.0242816. eCollection 2020.
Treatment for peritoneal malignancy (PM) can include cytoreductive surgery (CRS) and heated intrapertioneal chemotherapy (HIPEC) and is associated with morbidity and mortality. Physical, psychological and nutritional outcomes are important pre-operatively. The aim of this pilot study was to investigate these outcomes in patients with PM before and after CRS-HIPEC.
Between June 2018 and November 2019, participants were recruited to a single-centre study. Primary outcome was cardiopulmonary exercise testing (CPET) variables oxygen uptake (VO2) at anaerobic threshold (AT) and at peak. Secondary outcome measures were upper and lower body strength, health related quality of life (HRQoL) and the surgical fear questionnaire. Exploratory outcomes included body mass index, nutrient intake and post-operative outcome. All participants were asked to undertake assessments pre CRS-HIPEC and 12 weeks following the procedure.
Thirty-nine patients were screened, 38 were eligible and 16 were recruited. Ten female and 6 male, median (IQR) age 53 (42-63) years. Of the 16 patients recruited, 14 proceeded with CRS-HIPEC and 10 competed the follow up assessment at week 12. Pre-operative VO2 at AT and peak was 16.8 (13.7-18) ml.kg-1.min-1 and 22.2 (19.3-25.3) ml.kg-1.min-1, upper body strength was 25.9 (20.3-41.5) kg, lower body strength was 14 (10.4-20.3) sec, HRQoL (overall health status) was 72.5 (46.3-80) % whilst overall surgical fear was 39 (30.5-51). The VO2 at AT decreased significantly (p = 0.05) and HRQoL improved (p = 0.04) between pre and post- CRS-HIPEC. There were no significant differences for any of the other outcome measures.
This pilot study showed a significant decrease in VO2 at AT and an improvement in overall HRQoL at the 12 week follow up. The findings will inform a larger study design to investigate a prehabilitation and rehabilitation cancer survivorship programme.
腹膜恶性肿瘤（PM）的治疗包括细胞减灭术（CRS）和腹腔内热化疗（HIPEC），与发病率和死亡率有关。身体、心理和营养状况是术前的重要指标。本研究旨在探讨 PM 患者在接受 CRS-HIPEC 前后的这些指标。
2018 年 6 月至 2019 年 11 月，我们在单中心进行了一项研究。主要结局是心肺运动试验（CPET）的变量，包括无氧阈（AT）和峰值时的摄氧量（VO2）。次要结局指标包括上下肢力量、健康相关生活质量（HRQoL）和手术恐惧问卷。探索性结局包括体重指数、营养摄入和术后结局。所有参与者在接受 CRS-HIPEC 前和术后 12 周接受评估。
共有 39 名患者接受了筛选，38 名符合条件，16 名患者被招募。10 名女性和 6 名男性，中位（IQR）年龄为 53（42-63）岁。在 16 名被招募的患者中，14 名接受了 CRS-HIPEC，10 名在第 12 周完成了随访评估。术前 AT 和峰值时的 VO2 分别为 16.8（13.7-18）ml·kg-1·min-1和 22.2（19.3-25.3）ml·kg-1·min-1，上半身力量为 25.9（20.3-41.5）kg，下半身力量为 14（10.4-20.3）s，HRQoL（总体健康状况）为 72.5（46.3-80）%，而整体手术恐惧为 39（30.5-51）。CRS-HIPEC 前后 AT 时的 VO2 显著下降（p = 0.05），HRQoL 改善（p = 0.04）。其他结局指标无显著差异。
本研究表明，AT 时的 VO2 显著下降，12 周随访时整体 HRQoL 改善。这些发现将为进一步研究术前和康复期癌症生存者的康复计划提供信息。
