Pain, pain management and related outcomes following pelvic exenteration surgery: a systematic review

Aim Pelvic exenteration surgery can improve survival in people with advanced colorectal cancer. This systematic review aimed to review pain intensity and other outcomes, for example the management of pain, the relationship between pain and the extent of surgery and the impact of pain on short‐term o...

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Bibliographic Details
Published in:Colorectal disease 2023-04, Vol.25 (4), p.562-572
Main Authors: Johnstone, Charlotte S. H., Roberts, Daniel, Mathieson, Stephanie, Steffens, Daniel, Koh, Cherry E., Solomon, Michael J., McLachlan, Andrew J.
Format: Article
Language:English
Subjects:
Adult
cancer
Colorectal carcinoma
Colorectal Neoplasms - surgery
Humans
Middle Aged
Neoplasm Recurrence, Local - surgery
Pain
Pain Management
Pain, Postoperative - etiology
pelvic exenteration
Pelvic Exenteration - adverse effects
Retrospective Studies
Surgery
Systematic review
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Summary:Aim Pelvic exenteration surgery can improve survival in people with advanced colorectal cancer. This systematic review aimed to review pain intensity and other outcomes, for example the management of pain, the relationship between pain and the extent of surgery and the impact of pain on short‐term outcomes. Method Electronic databases were searched from inception to 1 May 2021. We included interventional studies of adults with any indication for pelvic exenteration surgery that also reported pain outcomes. Risk of bias was assessed using ROBINS‐1. Results The search found 21 studies that reported pain following pelvic exenteration [n = 1317 patients, mean age 58.4 years (SD 4.8)]. Ten studies were judged to be at moderate risk of bias. Before pelvic exenteration, pain was reported by 19%–100% of patients. Five studies used validated measures of pain intensity. No study measured pain at all three time points in the surgical journey. The presence of pain before surgery predicted postoperative adverse pain outcomes, and pain is more likely to be experienced in those who require wider resections, including bone resection. Conclusion Considering that pain following pelvic exenteration is commonly described by patients, the literature suggests that this symptom is not being measured and therefore addressed.
ISSN:1462-8910
1463-1318
DOI:10.1111/codi.16462