Long-term quality of life and its determinants in gynecologic cancer survivors after pelvic exenteration

This study aimed to evaluate long-term quality of life (QoL) in gynecologic cancer survivors after pelvic exenteration (PE) and to identify clinical factors associated with impaired QoL. This retrospective cohort study included patients with gynecologic cancer who underwent PE at a tertiary referral center between January 2015 and December 2022. Demographic, clinical, surgical, and treatment-related variables were collected from institutional records. Univariate analyses were performed to identify factors associated with global QoL scores, and variables with P < .10 were entered into a multivariable linear regression model. A total of 58 patients were included, with a median age of 56 years and a median follow-up of 38 months. The mean global QoL score was 62.4 ± 14.7. Patients with permanent stoma formation reported significantly lower global QoL than those without stoma (57.1 vs 72.3, P < .001). In multivariable analysis, permanent stoma formation ( B = −12.73, 95% confidence interval [CI] = −19.62 to −5.85; standardized β = −0.41; P < .001), severe postoperative complications ( B = −10.65, 95% CI = −17.75 to −3.55; β = −0.32; P = .004), tumor recurrence during follow-up ( B = −8.71, 95% CI = −15.05 to −2.37; β = −0.29; P = .008), and postoperative radiotherapy ( B = −6.14, 95% CI = −11.69 to −0.58; β = −0.21; P = .031) were independently associated with lower global QoL. The model had an adjusted R 2 of 0.42 ( F [4,53] = 7.99, P < .001). In a sensitivity analysis additionally adjusting for primary tumor site, primary versus recurrent disease at PE, and time from surgery to QoL assessment, the direction of the main associations remained unchanged, although the effect of postoperative radiotherapy was attenuated ( P = .061). Gynecologic cancer survivors undergoing PE may achieve moderate long-term QoL, although persistent symptom burden remains common. Permanent stoma formation, severe postoperative complications, tumor recurrence, and postoperative radiotherapy were associated with poorer QoL. These findings support careful patient counseling, optimized perioperative management, and multidisciplinary survivorship care after PE.