Long-term survival and quality of life in patients more than 10 years after pelvic exenteration.

Abstract

Pelvic exenteration is a curative treatment option for selected patients with advanced primary or recurrent pelvic cancer. This study aimed to evaluate survival and quality-of-life outcomes beyond 10 and up to 17 years following pelvic exenteration. This longitudinal study included patients who underwent pelvic exenteration between 2008 and 2014. Quality of life was assessed using Short-Form Survey (SF-36v2) and Functional Assessment of Cancer Therapy-Colorectal Cancer (FACT-C) questionnaires at 10 different time points from baseline up to 17 years following pelvic exenteration. Survival data were obtained through registry linkage, with outcomes analysed using Kaplan-Meier methods. Of the 273 patients included (median age 61.0 years, 59.3% male), 91 (33%) survived beyond 10 years. Median overall survival was 4.8 years (95% c.i. = 3.6 to 6.0), with survival rates of 48.4%, 35.1%, and 31.5% at 5, 10, and 15 years respectively. In the 216/273 (79.1%) patients who consented to participate in quality-of-life surveys, 32 (15%) completed surveys beyond 10 years. FACT-C scores showed steady improvement over the first 18 months, maintaining thereafter. Mental Component Summary scores approached population norms after initial improvement, while Physical Component Summary scores stayed within the population norm and remained stable throughout the follow-up period. In a specialized setting, pelvic exenteration shows promising long-term outcomes with one-third of patients surviving beyond 10 years. Quality-of-life measures demonstrate sustained improvement and are comparable to population norms in several domains, supporting its use as a curative treatment for selected patients with advanced and recurrent pelvic malignancies.