Background Pelvic exenteration (PE) is a morbid procedure. While quality of life (QoL) studies have demonstrated good long term QoL, these QoL instruments do not allow clinicians to understand what matters to patients at an individual level and what patient priorities are. This study aims to understand what objectives are important to patients when undergoing PE. Methods Patients undergoing PE at Royal Prince Alfred Hospital were prospectively recruited. Direct Questioning of Objectives Questionnaire was used to assess patient objectives. Patients nominated and rated the importance of their objectives. Additionally, patients were also asked to rate their ability to perform this objective. A higher score indicates higher importance and better ability. Assessments were performed at baseline and 12-months after surgery. Objectives were categorized based on themes. Categorical variables were compared using X2. Results There were 243 patients. The mean number of objectives per patient was 2.7(+/- 1.2). The most common objective was the “ability to exercise” with 70.4% of patients nominating this as a priority. “Family life/ personal relationships”, “ability to travel”, “ability to work” and “independence with activities of daily-living” were of intermediate importance with up to 38.3% of patients listing them as objectives. 20.1% of patients changed their objectives between time-points. Although not statistically significant, these patients were more likely to have complicated surgery with longer duration of surgery, longer length of stay, higher re-operation rates and lower R0 resection rates. Conclusion Understanding what matters to patient will better help clinicians improve patient QoL.