Pelvic exenteration for cervical cancer – Oncologic outcome and long-term health-related quality of life, a mixed methods study

BACKGROUND: Pelvic exenteration (PE) is a potentially curative but highly morbid treatment for recurrent cervical cancer. Evidence on long-term oncologic outcomes and survivorship experiences remain limited. METHODS: This mixed-methods study included 55 patients treated with PE for recurring cervical cancer at Oslo University Hospital between 1995 and 2020. Oncological outcomes were analyzed retrospectively. A subgroup of ten long-term, recurrence-free survivors underwent clinical examination, completed validated patient-reported outcome measures, and participated in semi-structured qualitative interviews. Reflexive thematic analysis was applied to interview data. RESULTS: Ninety-day major (grade ≥ 3) complications occurred in 53% of patients; 4% died postoperatively. After median follow-up of 14 years, five-year overall and cancer-specific survival were 46% and 52%, respectively. An interval > 12 months between primary chemoradiation and PE was independently associated with improved survival (HR 0.38, 95% CI 0.16-0.87). Among survivors (median 9 years post-PE, range 5-18), quantitative HRQoL showed generally preserved global and functional scores, though social functioning, diarrhea, and financial difficulties reached clinical relevance. Anxiety and depression levels were low overall. In contrast, qualitative findings revealed substantial and persistent physical, practical, and relational challenges. Ostomies imposed significant social and logistical burdens, fatigue and pain constrained daily life, and most participants reported permanent loss of sexual function and altered body image. Despite these sequelae, nearly all participants considered the surgery worthwhile. CONCLUSIONS: PE offers meaningful long-term survival for selected patients, particularly with longer recurrence-free intervals. Although standardized measures suggest acceptable long-term HRQoL, qualitative data demonstrate enduring physical and psychosocial burdens, underscoring the importance of tailored counselling and multidisciplinary long-term follow-up.