Palliative pelvic exenteration: clinical outcomes and quality of life

BACKGROUND: Locally advanced pelvic malignancy can be associated with disabling symptoms and reduced quality of life. If resectable with clear margins, a pelvic exenteration can offer long-term survival and improved quality of life. Its role in the palliation of symptoms has been described; however, the clinical outcomes and surgical indication are poorly defined. OBJECTIVE: This study describes the clinical and quality-of-life outcomes after palliative pelvic exenteration for advanced pelvic malignancy. DESIGN: Clinical data and patient-reported outcomes were collected for patients undergoing pelvic exenteration for symptom palliation. SETTINGS: This study was conducted at a tertiary referral center for pelvic exenteration. PATIENTS: All of the patients undergoing palliative pelvic exenteration for advanced primary rectal or recurrent cancer were included in our analysis. MAIN OUTCOME MEASURES: Patient-reported quality of life and physical and mental health status were measured. Quality-of-life trajectories were modeled over the 12 months from the date of surgery using linear mixed models. RESULTS: A total of 39 patients underwent pelvic exenteration for symptom palliation. Although there were no in-hospital deaths, 34% experienced significant morbidity. Patient-reported quality of life reduced postoperatively and gradually declined thereafter. Overall median survival was 24 months, with a 1-year mortality rate of 31%. There was a significant survival difference for the 39 patients undergoing pelvic exenteration compared with those patients who only had a debulking/bypass procedure or were closed without definitive treatment (overall median survival = 24 versus 9 months; p = <0.02). LIMITATIONS: Disease and patient heterogeneity limit the interpretation of these results. CONCLUSIONS: Palliative pelvic exenteration is a technically demanding operation that can be performed safely in a dedicated exenteration center. However, no durable palliation of symptoms with associated improved or sustained quality of life was observed, and the role of palliation therefore remains highly controversial in this complex group of patients.