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Abstract
Introduction With recent advances, pelvic exenteration (EXT) can offer potentially curative options for recurrent malignancies but remains highly morbid.
Methods Patients with recurrent malignancies scheduled for EXT were interviewed pre-EXT, at 3-,6-,12-months post-EXT (mos), and annually until 5 years(yr) using the European Organization for Research and Treatment of Cancer (EORTC)-QLQ-C30, and -BLM-30 questionnaires. Scores are reported as median (IQR).
Results Out of 53 patients, 29(55%) had continent urinary diversion (CD) and 24(45%) had non-continent diversion (NCD) procedures. Median age was 61(50–68) years. Cancer sites included vagina 8(15%), cervix 20(38%), uterus 13(25%), vulva 10(19%), and ovary 1(2%). Overall QOL and global health status improved significantly by 1 yr when compared to baseline (p= 0.008) (figure 1). High body image scores, indicative of negative self-image, improved to baseline for the entire cohort 1 yr post-EXT (figure 2). When stratified based on diversion, body image scores remained lower in CD compared to NCD. Physical function scores at 3-mos declined by 15(11–21) points from baseline (p<0.001) and returned to baseline at 2 yrs, however remained higher for CD than NCD (p=0.048). Similarly, social function scores at 3 yrs were higher for CD versus NCD (100 (IQR:83–100) versus 89(IQR:67–83), p=0.002). Three-mos fatigue scores increased by 11(I4–19) points from baseline (p=0.01) and were lower for CD (17(IQR:0–25)) compared to NCD (33(IQR:22–33)) (p=0.04).
Conclusion/Implications Type of urinary diversion affects QoL in patients undergoing EXT. CD was associated with better body image, physical and social functions. These findings can help with preoperative counseling and postoperative management to provide patients the needed resources for a better quality of life.
a: QoL score evolution for CD vs NCD patients during the study period. b: Delta-QoL Score comparing scores at each timepoint to baseline for the entire cohort (timepoints highlighted in dark gray are significant after adjustment for multiple comparisons)
a: Body Image (BI) score evolution with time for patients with CD and NCO (timepoints highlighted in dark gray are significant before adjustment for multiple comparisons). b: Delta-BI score comparing scores at each timepoint to baseline for the entire cohort (timepoints highlighted in dark gray are significant after adjustment for multiple comparisons)