盆腔脏器联合切除术（PE）是治疗局部晚期或复发性盆腔恶性肿瘤的根治性选择之一，但其创伤大、并发症率高、围手术期死亡风险显著，使临床决策和患者选择极具挑战性。传统研究多聚焦于R0切除率、生存率等“医生视角”的结局，而相对忽视患者长期生活质量和决策体验。近年来，加速康复外科（ERAS）理念被逐步引入PE，但现有证据提示：一方面，在PE中应用ERAS与住院时间缩短和重度并发症降低相关；另一方面，简单照搬常规结直肠或妇科ERAS路径，在PE人群中可能导致肠麻痹、尿漏和盆腔脓肿等并发症发生率增加。患者报告结局（PROMs）及生活质量标准（QoL）等指标显示，部分患者即使获得R0切除和长期生存，仍对接受PE的决定持矛盾心理，甚至存在决策后悔。本文在梳理PE解剖和人群特征、围手术期挑战的基础上，系统总结ERAS在PE中的应用现状与主要研究结果，综述PE后长期生存和生活质量的证据，重点讨论医生视角与患者视角在结局评价上的差异，并提出以风险分层和PROMs为基础的PE专属ERAS路径及多学科、以患者为中心的管理建议，以期为临床实践和未来研究提供参考框架。

Pelvic exenteration (PE) is one of the radical surgical options for treating locally advanced or recurrent pelvic malignancies. However, due to its high degree of invasiveness, elevated complication rates, and significant perioperative mortality, clinical decision-making and patient selection present substantial challenges. Traditional studies have primarily focused on outcomes from the physician’s perspective, such as R0 resection rates and survival, while often overlooking patients’ long-term quality of life and decision-making experiences. In recent years, the concept of enhanced recovery after surgery (ERAS) has been gradually introduced into PE. Current evidence suggests that while the application of ERAS in PE is associated with reduced hospital stays and a lower incidence of severe complications, the simple adoption of standard colorectal or gynecological ERAS protocols in the PE population may lead to increased complications such as intestinal paralysis, urinary leakage, and pelvic abscesses. Metrics including patient-reported outcomes (PROMs) and quality of life (QoL), indicate that some patients, even after achieving R0 resection and long-term survival, still express hesitation or regret regarding their decision to undergo PE. This review, based on an analysis of the anatomical and demographic characteristics of PE as well as perioperative challenges, systematically summarizes the current status and main findings of ERAS application in PE, synthesizes evidence on long-term survival and quality of life following PE, highlights the discrepancies in outcome evaluation between physician-centered and patient-centered perspectives, and proposes a risk-stratified, PROMs-based PE-specific ERAS pathway alongside multidisciplinary, patient-centered management recommendations. The aim is to provide a reference framework for clinical practice and future research.