title: Systematic review of health-related quality of life in patients undergoing pelvic exenteration.
abstract: BACKGROUND
  Pelvic exenteration is a radical operative treatment reserved for the management of a number of advanced primary and recurrent pelvic malignancies, including, rectal, gynaecological and urological. The advances in radiological staging, surgical techniques and greater use of chemotherapeutic agents haves translated clinically into improvements in the overall survival of this cohort of patients, irrespective of underlying disease pathology. Consequently, a greater proportion of the surviving population will present to healthcare professionals with a range of physical and psychological issues, therefore the profiling and understanding of the health-related quality of life (HrQoL) is integral to the long term management of this cohort of patients. The aim of this systematic review is to identify HrQoL themes from the current literature relevant to patients undergoing a pelvic exenteration.
  
  
  METHODS
  Literature searches were performed in three databases: MEDLINE (1975-November 2015), EMBASE and CINAHL. Each study was evaluated with regards to its design and statistical methodology. Data quality was reviewed in accordance with the Newcastle-Ottowa score and Critical Appraisal Skills Programme Checklist (CAPS) for quantitative and qualitative data accordingly. A narrative synthesis of all identified HrQoL issues was undertaken using the principles of content analysis.
  
  
  RESULTS
  A total of 24 studies were identified; 20 quantitative and 4 qualitative with 976 patients assessed in total. HrQoL was assessed as the main primary endpoint in 15 studies. The majority of studies were retrospective. Baseline data prior to the initiation of treatments were available in 6 studies alone. Nine themes were identified across the literature, which included body image, social impact, sexual function, treatment expectations, symptoms, communication, psychological impact, relationships and work and finance.
  
  
  CONCLUSIONS
  Pelvic exenteration has a wide ranging impact on patients HrQoL affecting a range of physical and psychological domains.
authors.affiliation: The John Goligher Department of Colorectal Surgery, St James's University Hospital, UK; Clinical Trials Research Unit, University of Leeds, UK. Electronic address: Deena_harji@hotmail.com.
authors.forename: D P
authors.initials: DP
authors.lastname: Harji
authors.affiliation: The John Goligher Department of Colorectal Surgery, St James's University Hospital, UK.
authors.forename: B
authors.initials: B
authors.lastname: Griffiths
authors.affiliation: Leeds Institute of Cancer and Oncology, University of Leeds, UK; St James's Institute of Oncology, St James's University Hospital, UK.
authors.forename: G
authors.initials: G
authors.lastname: Velikova
authors.affiliation: The John Goligher Department of Colorectal Surgery, St James's University Hospital, UK.
authors.forename: P M
authors.initials: PM
authors.lastname: Sagar
authors.affiliation: Clinical Trials Research Unit, University of Leeds, UK.
authors.forename: J
authors.initials: J
authors.lastname: Brown
mesh_terms: D000203:Activities of Daily Living; D004651:Employment; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery; D006304:Health Status; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008603:Mental Health; D010385:Pelvic Exenteration; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000601:surgery; D060728:Reproductive Health; D012380:Role; D058992:Social Participation; D014571:Urologic Neoplasms / Q000601:surgery
keywords: Health related quality of life; Pelvic exenteration; Quality of life