Advances in oncologic pelvic surgery and multimodal cancer treatment have improved long-term survival rates. However, functional complaints - including bowel, urinary, sexual and pelvic pain - remain common and can substantially impair quality of life. 
As part of a broader research program, we conducted a narrative review (2025) across gynaecologic, urologic and colorectal oncology to map the prevalence and spectrum of functional complaints after oncologic pelvic surgery. Twenty-eight studies were included using 20 different questionnaires. Bowel dysfunction emerged as the most consistently reported domain; major Low Anterior Resection Syndrome occurred in 14–69% of colorectal cohorts, 16–34% of gynaecological, and up to 37% in urological studies. Male sexual function deteriorated markedly across most studies, whereas findings regarding urinary function, female sexual function, and pain were heterogeneous. However, most studies assessed single organ systems, limiting insight into multidomain symptom clusters, perceived burden and help-seeking behaviour. These gaps underscore the need for prospective, multidomain assessment to better understand patient experienced morbidity and care needs. 
We hypothesized that functional complaints after oncologic pelvic surgery are common, often multidomain, associated with substantial perceived burden and insufficiently addressed, as reflected by limited help seeking behaviour.

Aim of the study
Building on our narrative review, this prospective study aimed to quantify the prevalence, perceived burden and multidomain distribution of functional complaints after oncologic pelvic surgery, and to evaluate patients’ help-seeking behaviour within the first postoperative year.

We conducted a prospective cohort study at a university hospital, running in parallel with our narrative review. Adult patients undergoing oncologic pelvic surgery within urology, gynaecology, and colorectal surgery were eligible. Baseline demographic, clinical, and treatment-related characteristics were extracted from electronic medical records after informed consent. Participants were invited to complete a brief, structured digital questionnaire at 3, 6, and 12 months postoperatively. Urinary, bowel, sexual and pain-related complaints, perceived burden was rated on a 0-10 numeric scale. Help-seeking behaviour was assessed by asking whether patients sought or intended to seek medical or allied healthcare consultation. Outcomes of this interim analysis were assessed using descriptive statistics.

Of 75 screened patients to date, 52 completed at least one questionnaire (response rate 69%; median age 64 years, median follow-up 6 months), and were distributed across urology (38.5%), colorectal surgery (36.4%) and gynaecology (26.9%). Functional complaints were highly prevalent: 56% reported at least one complaint, of whom 52% indicated they would seek help (Table 1, Figure 1). Multiple domain symptoms were reported by 34%, of whom 50% would seek help. Among urological and gynaecological patients, pelvic pain was most frequently reported symptom (29%, median burden score 5) followed by sexual dysfunction (21%, median burden score 5). In this subgroup, 44% reported intentions to seek professional help.

The preliminary findings from this ongoing study confirm and extend the patterns observed in our narrative review: functional complaints after oncologic pelvic surgery are common and frequently multidomain. The high prevalence of multidomain symptoms reflects the interconnected nature of pelvic floor function and highlights the limitations of organ-specific follow-up models. Importantly, our prospective data provide novel insight into perceived burden and help-seeking behaviour, revealing a mismatch between symptom impact and help-seeking. This suggests that functional morbidity remains underrecognized and insufficiently addressed.

Functional complaints after oncologic pelvic surgery are common, often multidomain, and associated with substantial perceived burden. Help-seeking behaviour remains limited, indicating that patients may not proactively report symptoms. Structured, systematic assessment of functional outcomes during post-operative follow-up is essential to identify unmet supportive care needs and to provide effective, patient-centred management.