Pelvic Exenteration: Oncological and Surgical Outcomes From a Single Tertiary Statewide Service

Advancements in the multidisciplinary management of locally advanced and recurrent rectal cancer, as well as advanced pelvic malignancies, have significantly improved oncological outcomes. Pelvic exenteration is a complex procedure involving en bloc resection of the involved organs with the aim of achieving a microscopic negative margin (R0)¹. Since 2012, the Royal Brisbane and Women's Hospital (RBWH) has been performing pelvic exenteration surgery and is now the statewide referral centre in Queensland. This study aims to present our oncological and surgical outcomes since establishment.

This is a retrospective cohort study utilising data collected from medical records of patients who underwent pelvic exenteration at the RBWH between 1 January 2012 and 31 August 2023. Ethics approval was obtained from the Metro North Hospital and Health Service Human Research Ethics Committee (HREC 102257).

A total of 139 patients underwent pelvic exenteration surgery over the 11-year period. 117 of those were total exenteration, 22 were partial. The indications were locally advanced rectal cancer (56.8%), locally recurrent rectal cancer (22.3%), other primary or recurrent malignancy or benign, (10.8%, 7.9%, 2.2% respectively). The proportion of patients with an R0 resection was 90.4%. The overall survival (using Kaplan-Meier analysis) at 1, 2 and 5 years was 89.9%, 82.0%, and 62.9%, respectively. Disease-free survival at 1, 2 and 5 years was 76.1%, 67.0% and 59.2%. Disease-specific survival at 1, 2 and 5 years was 92.7%, 83.8% and 66.8%.

Our results were comparable to national data and PelvEx Collaborative group data and demonstrate that pelvic exenteration surgery can be safely performed in a lower volume centre with equivalent outcomes to higher volume centres.