The quality of patient preparation for exenterative surgery

Abstract

Total pelvic exenteration is a complex major operation involving the removal of all organs from the pelvis, which mandates diversion of both urine and faeces. The sequelae of surgery are undeniably life-altering. Carefully considered multidisciplinary, pre-operative preparation is essential to mitigate the psychological and physical stresses of such surgery. There are several areas of unmet need in cancer surgery, and these deficiencies are highlighted in procedures of this complexity. Multiple factors influence pre-operative preparation, including the quality, timing and format of patient information, as well as the patient's language needs and level of literacy. Surgical preparation should also include opportunities for prehabilitation, and therefore timing of information is crucial, particularly as these patients are usually undergoing intensive neo-adjuvant treatments, including chemo- and radiotherapy. Peer support is also considered important, although little is known about the benefits of peer relationships in major pelvic surgery. This article discusses how patients are prepared at the Royal Marsden NHS Foundation Trust and highlights opportunities for further research, the aim of which is to improve outcomes and quality of life.