Living After Pelvic Exenteration: A Mixed-Methods Synthesis of Quality-of-Life Outcomes and Patient Perspectives

Background/Objective: Pelvic exenteration (PE) is a radical procedure with significant physical and psychosocial consequences. Despite increasing survival rate following PE, quality of life (QoL) outcomes remain inconsistently reported and poorly understood in clinical practice. This study aims to explore: (1) What is the current evidence on QoL after pelvic exenterations? and (2) How do patient-reported experiences align with or differ from findings in the literature? Methods: We conducted a mixed-methods study consisting of two components: (1) a qualitative analysis of 5 in-depth, semi-structured interviews with patients who underwent PE for advanced pelvic cancers; and (2) a narrative review of 28 quantitative and qualitative studies evaluating QoL after PE, published between 1975 and 2023, encompassing 1149 patients. Thematic analysis was performed using an interpretative phenomenological approach. Results: Qualitative findings revealed recurrent themes of identity disruption, social withdrawal, emotional resilience, and a need for personalized, preoperative information. Patients often described a mismatch between surgical expectations and lived experience, and expressed a strong desire for better psychological support and realistic communication. The review of published studies showed heterogeneous findings, with moderate recovery in global QoL scores by 6-12 months postoperatively, but persistent impairments in physical function, sexual health, and emotional well-being. Only a minority of studies included patient-reported outcomes tailored to specific domains such as body image or psychological adaptation (17.8%). Conclusions: Recovery after pelvic exenteration extends beyond physical healing and requires attention to emotional, social, and existential dimensions. Integrating psycho-oncologic support and patient-centered communication into standard care is essential. This hybrid analysis underscores the importance of addressing quality of life proactively-not only as an outcome, but as a fundamental component of survivorship care.