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Pelvic exenteration: Pre-, intra-, and post-operative considerations.

Kheng-Seong Ng1, Peter J M Lee1

  • 1Royal Prince Alfred Hospital, Department of Colorectal Surgery, Sydney, Australia; Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Sydney, Australia.

Surgical Oncology
|April 2, 2021
PubMed
Summary

Pelvic exenteration (PE) is a complex surgery for advanced rectal cancers. Achieving an R0 resection is key for survival and quality of life, despite the procedure

Keywords:
Colorectal cancerLocally advanced rectal cancerPelvic exenterationQuality of lifeR0 resectionRecurrent rectal cancer

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Area of Science:

  • Surgical Oncology
  • Gastroenterology
  • Pelvic Surgery

Background:

  • Pelvic exenteration (PE) is a radical surgical procedure for locally advanced or recurrent rectal cancers.
  • Significant advancements have been made in pre-, intra-, and post-operative care to improve outcomes.

Purpose of the Study:

  • To review the evolving role and techniques of pelvic exenteration in rectal cancer management.
  • To highlight the importance of R0 resection and patient selection.

Main Methods:

  • Review of current literature on pelvic exenteration for rectal cancer.
  • Discussion of surgical techniques, anatomical compartment approach, and innovative dissection planes.
  • Emphasis on pre-operative imaging (MRI, PET) and post-operative care considerations.

Main Results:

  • R0 resection is the most critical factor influencing survival, quality of life, morbidity, and cost-effectiveness.
  • Advanced surgical techniques enable en bloc excision with improved resection rates.
  • Despite morbidity, quality of life typically recovers within six months post-surgery.

Conclusions:

  • Pelvic exenteration, when meticulously planned and executed, offers survival benefits for selected rectal cancer patients.
  • Continuous innovation in surgical approaches and supportive care is crucial for optimizing PE outcomes.
  • Careful patient selection and management of post-operative complications are essential for successful PE.