Objectives: This retrospective, multicentric study investigates quality-of-life issues andemotional distress in gynecological cancer survivors submitted to pelvic exenteration (PE).Methods: The Global Health Status scale of European Organization for Research andTreatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30; the EORTCQLQ-CX24 (CX24), and EORTC QLQ-OV28 questionnaires were administered at least12 months from surgery only in women with no evidence of further recurrence after PE.Statistical analysis was performed by the analysis of variance (for repeated measures.Results: Ninety-six subjects affected by gynecological malignancies receiving PE wereenrolled in the study. Anterior PE was performed in 47 patients (49%), posterior PE wasperformed in 29 cases (30.2%), and total PE performed in 20 women (20.8%). In 38 cases(39.6%), a definitive colostomy was performed. Urinary diversion with continent pouchwas created in 11 patients. (11.5%), whereas in the remaining cases, a noncontinentpouch was reconstructed. Patients showed a significant discomfort in attitude to disease(71.5 T 4.7), body image (48.9 T 6.4), financial difficulties (56.2 T 5.8), gastrointestinalsymptoms (constipation, 47.8 T 5.1; diarrhea, 62.4 T 6.6; appetite loss, 43.6 T 6.7), insomnia(64.5 T 6.6), Global Health Status (64.6 T 3.8), physical functioning (65.8 T 4.6), rolefunctioning (58.8 T 5.8), and emotional functioning (67.4 T 4.2). A higher number ofostomies (hazard rate [HR], 7.613; P = 0.012), the creation of a noncontinent bladder(HR, 8.230; P = 0.009), and of definitive colostomy (HR, 8.516; P = 0.008) emergedas independent predictors of poorer Global Health Status scores. Older age (HR, 11.235;P = 0.003), vaginal/vulvar cancer (HR, 7.369; P = 0.013), total/posterior PE (HR, 7.393;P = 0.013), higher number of ostomies (HR, 7.613; P = 0.012), the creation of anoncontinent bladder (HR, 8.230; P = 0.009), and of definitive colostomy (HR, 8.516;P = 0.008) emerged as independent predictors of lower body image levels.Conclusions: Long-term psycho-oncological support is strongly recommended. Thereduction of ostomies seems the most effective way to improve patients’ quality of life.
- Obstetrics and Gynaecology