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Oncovascular Resection in Pelvic Exenteration: A Systematic Review
Joshua Richard Burke1,2,3, Yasmin Oskui1, Imogen Samuel1
1Colorectal & Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK.
ANZ Journal of Surgery
|July 7, 2026
Summary
Oncovascular pelvic exenteration achieved R0 resection in approximately two-thirds of patients, with a 1.9% 30-day mortality rate. Further research and improved patient selection are needed to enhance outcomes in this pioneering surgical field.
Area of Science:
- Oncovascular surgery
- Pelvic exenteration
- Advanced pelvic malignancy
Background:
- Resection of major vascular structures may be necessary for R0 resection in pelvic exenteration for advanced pelvic malignancy.
- Limited evidence exists for pelvic oncovascular techniques and patient outcomes are not widely reported.
Purpose of the Study:
- To systematically review the current literature on R0 resection rates and 30-day mortality following oncovascular pelvic exenteration.
Main Methods:
- A systematic review of MEDLINE, EMBASE, Cochrane Library, and Web of Science was conducted.
- Studies on oncovascular resection in advanced pelvic malignancy were included; pre-1980 studies were excluded from quantitative synthesis.
- Data on R0 resection, postoperative morbidity, and mortality were extracted and bias was assessed using the ROBINS-1 V2 tool.
Main Results:
- Seventeen studies met inclusion criteria, with 411 patients in quantitative analysis.
- The R0 resection rate was 65.3% among curative-intent procedures (n=334).
- Thirty-day mortality was 1.9% (8/411), with overall survival of 41 months and disease-free survival of 27 months.
Conclusions:
- Oncovascular pelvic exenteration achieves R0 resection in approximately two-thirds of patients, with 1.9% 30-day mortality.
- Outcomes are currently inferior to conventional exenteration, indicating the pioneering phase of this practice.
- Future efforts should focus on centralization, rigorous audit, benchmarking, and improved patient selection to enhance R0 and complication rates.
