A prospective investigation of pain and fatigue following pelvic exenteration.

AIM

To describe the long-term course of pain and fatigue in patients undergoing pelvic exenteration and to evaluate potential prognostic factors for these outcomes.

DESIGN

Prospective cohort study.

SETTINGS

Royal Prince Alfred Hospital, Sydney, Australia.

PATIENTS

Consecutive patients undergoing pelvic exenteration surgery between July 2008 and December 2017.

MAIN OUTCOME MEASURES

Pain and fatigue scores collected via SF-36v2 Health surveys pre-operatively and at eight time-points post-operatively for a period of 5-years. The course of pain and fatigue were described according to the following prognostic factors; bone resection (yes/no), cancer type (primary/recurrent), margin status (R0/R1-2) and extent of exenteration (complete/partial).

RESULTS

345 of 459 eligible patients (75 %) consented to the study. The course of pain and fatigue over the 5 year follow-up was favourable. Patients undergoing pelvic exenteration with an R0 resection margin or without bone resection presented lower pain levels throughout the follow-up period. Bone resection, positive surgical margin (R1/R2) and type of cancer did not influence fatigue trajectories. Patients undergoing complete pelvic exenteration were more likely to report a higher level of pain and fatigue in the initial follow-up period, however this difference was not observed in the longer-term.

CONCLUSIONS

Patients undergoing PE (Austin and Solomon, 2015) [1] can expect improvement but an incomplete recovery in the levels of pain and fatigue postoperatively over the 5-year follow-up period. Bone resection as part of exenteration demonstrated higher levels of pain and fatigue.