title: Quality of life and other patient-reported outcomes following exenteration for pelvic malignancy.
abstract: BACKGROUND
  Pelvic exenteration is highly radical surgery offering the only potential cure for locally advanced pelvic cancer. This study compared quality of life and other relevant patient-reported outcomes over 12 months for patients who did and those who did not undergo pelvic exenteration.
  
  
  METHODS
  Consecutive patients referred for consideration of pelvic exenteration completed clinical and patient-reported outcome assessments at baseline, hospital discharge (exenteration patients only), and 1, 3, 6, 9 and 12 months. Outcomes included cancer-specific quality of life (Functional Assessment of Cancer Therapy - Colorectal; FACT-C), physical and mental health status (Short Form 36 version 2), psychological distress (Distress Thermometer), and pain (study-specific composite) scores. Linear mixed modelling compared trajectories between exenteration and no-exenteration groups.
  
  
  RESULTS
  Among 182 patients, 148 (81.3 per cent) proceeded to exenteration. There were no baseline differences between the two groups. Among patients who had exenteration, the mean FACT-C score at baseline of 93.0 had reduced by 14·4 points at hospital discharge, but increased to 86·7 at 1 month after surgery and continued to improve, returning to baseline by 9 months. For patients in the no-exenteration group, FACT-C scores decreased between baseline and 1 month, increased slowly to 6 months and then began to decline at 9 months. There were few statistically or clinically significant differences in any patient-reported outcomes between the groups.
  
  
  CONCLUSIONS
  Quality of life and related patient-reported outcomes improve rapidly after pelvic exenteration surgery. For 9 months after surgery, these outcomes are comparable with those of similar do patients who do not have surgery; thereafter, there is a decline in patients who do not have exenteration. Pelvic exenteration can be performed with acceptable quality of life and patient-reported outcomes.
authors.affiliation: Cancer Epidemiology and Cancer Services Research, Sydney School of Public Health, Sydney, Australia; Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: J M
authors.initials: JM
authors.lastname: Young
authors.forename: T
authors.initials: T
authors.lastname: Badgery-Parker
authors.forename: L M
authors.initials: LM
authors.lastname: Masya
authors.forename: M
authors.initials: M
authors.lastname: King
authors.forename: C
authors.initials: C
authors.lastname: Koh
authors.forename: A C
authors.initials: AC
authors.lastname: Lynch
authors.forename: A G
authors.initials: AG
authors.lastname: Heriot
authors.forename: M J
authors.initials: MJ
authors.lastname: Solomon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010385:Pelvic Exenteration / Q000379:methods* / Q000401:mortality; D010386:Pelvic Neoplasms / Q000401:mortality / Q000601:surgery*; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult