Pelvic exenteration: a review of current issues/controversies

Area of Science:

• Oncology
• Surgical Oncology
• Pelvic Cancer Management

Background:

• Advanced or recurrent pelvic cancer management has seen significant evolution.
• Surgical techniques and multidisciplinary approaches have improved outcomes for patients with previously inoperable tumors.
• Rectal cancer recurrence rates range from 10-15% post-proctectomy.

Purpose of the Study:

• To review current controversies and advancements in the surgical management of advanced and recurrent pelvic cancers.
• To discuss the role and limitations of exenteration in pelvic oncology.
• To explore the impact of surgical interventions on survival, quality of life, and function.

Main Methods:

• Review of recent literature on pelvic exenteration and advanced pelvic cancer management.
• Discussion of surgical techniques, reconstruction, and multidisciplinary care.
• Analysis of outcomes including R0 resection rates, survival, and quality of life.

Main Results:

• Advances have led to reduced mortality and morbidity, with over 50% 5-year survival reported for rectal cancer with R0 resection.
• Exenteration is an established treatment for advanced/recurrent pelvic tumors, improving curative potential.
• Controversies persist regarding resection limitations, re-exenteration, and management in metastatic settings.

Conclusions:

• Surgical management, particularly exenteration, has transformed outcomes for advanced pelvic cancers.
• Further research and discussion are needed to address remaining controversies in exenteration.
• Optimizing treatment strategies is crucial for improving survival and quality of life in these patients.