Long-Term Consequences of Exenterative Surgery for People With Pelvic Cancer

Abstract

Background: For people with recurrent or locally advanced pelvic cancer with no evidence of metastatic spread, pelvic exenteration (PE) surgery that achieves clear (R0) resection margins is the only potentially curative treatment option. This extensive, radical surgery can involve removal of the pelvic organs, muscles, nerves and bone, resulting in significant impairment for patients. Aim: The aim of this study was to describe the long-term quality of life outcomes for this procedure, specifically to investigate levels of pain, vitality and depression among survivors 3 or more years after surgery. Methods: The Royal Prince Alfred Hospital in Sydney is a national referral center for PE in Australia. Patient-reported outcome measures, including generic (SF36) and colorectal cancer-specific (FACT-C) measures of quality of life (QoL), pain, vitality and depression were assessed presurgery, every 6 months to 3 years and then annually. Consecutive patients who were 3 or more years after PE comprised the sample for this study. Trajectories for patient-reported outcomes were plotted and the proportion of survivors who experienced ongoing pain, vitality and depression at each time point were calculated. Results: Among 251 patients who were 3 years post-PE, 131 (52%, 95% CI: 46%-58%) had died and 3-year QoL assessments were completed by 69 (58%) of survivors. Three years after surgery, mean QoL scores were similar to baseline and remained fairly stable among survivors to 5 years. There was a small decrease over time in the proportion of survivors reporting ongoing pain. From 3 years onwards, ∼77% (95% CI: 67%-87%) of survivors reported ongoing pain and 44% (95% CI: 32%-56%) reported some level of depression. However, SF-36 vitality scores increased slightly from a mean of 47.2 pre-PE to 49.0 at 3 years. Conclusion: Despite the extensive nature of PE surgery, the majority of survivors achieved reasonable long-term quality of life. However, high levels of chronic pain and depression indicate ongoing needs for supportive care in this patient group.