Quality of Life Outcomes Following Pelvic Exenteration for Gynaecological Malignancies: A Systematic Review

Background/Aim: Pelvic exenteration (PE) remains one of the most radical procedures in gynaecological oncology and is associated with substantial morbidity and long-term complications. We aimed to synthesise evidence on short and long-term QoL outcomes following PE for advanced or recurrent gynaecological malignancies. Methods: A systematic review was conducted using a prospectively registered protocol and reported in accordance with PRISMA guidelines. MEDLINE, Embase, PubMed and the Cochrane Library were searched from inception to October 2025. Eligible studies reported on one or more patient outcomes, including generic health QoL, sexual function, body image, menopausal symptoms and/or psychological distress. Risk of bias was assessed using ROBINS-I. Qualitative data synthesis was undertaken. Results: A total of 23 studies comprising 1,655 patients were included, of whom 746 contributed QoL data. No randomised trials were identified. There were equal numbers of prospective and retrospective studies (11/23 each), and 17/23 studies carried a serious risk of bias. Global QoL trajectories were variable in the early postoperative period, with 2/9 studies reporting deterioration, 3/9 stability and 4/9 improvement within the first six months. Beyond six months, most studies (5/9) demonstrated stabilisation or recovery (3/9) of QoL. In contrast, domain-specific morbidity was common and persistent. Sexual function deteriorated in 11/14 studies, body image worsened in 8/12 studies (often associated with stoma formation) and psychological distress increased in all studies assessing this outcome. Dual stomas, infra/trans-levator resections and adjuvant radiotherapy were associated with poorer QoL, while vaginal reconstruction was associated with improved outcomes. Conclusion: PE may permit acceptable long-term global QoL in selected women; however, this is frequently achieved at the cost of sustained sexual, body image and psychological morbidity. Multidimensional QoL assessment should be integral to patient selection, counselling and survivorship care. There is an imminent need for future prospective studies with standardised longitudinal QoL.