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Published on: February 12, 2022
Outcomes and Feasibility of Robotic Pelvic Exenteration for Palliative and Mixed Intent
Evrim Erdemoglu1, Isabella C Varea2, Javier Magrina3
1Department of Medical and Surgical Gynecology, Mayo Clinic, 5779 E. Mayo Blvd., 3(rd) Floor, Phoenix, 85054, Arizona, USA; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Suleyman Demirel University, Turkey; Süleyman Demirel Üniversitesi, Araştırma ve Uygulama Hastanesi, Doğu Yerleşkesi, Çünür, 32200 Isparta, Turkey.
Study Objective:
Pelvic exenteration is typically reserved for recurrent gynecologic malignancies, most often with curative intent. Its role in palliation, particularly using minimally invasive techniques, is less well defined.
Design And Setting:
This retospective case series evaluates the feasibility and outcomes of robotic-assisted pelvic exenteration performed with palliative intent between 2015 and 2025 at a single tertiary care institution.
Participants And Interventions:
Eleven patients with recurrent or advanced gynecologic cancers underwent robotic exenteration primarily for symptom relief-pain, bleeding, fistulae, or obstruction-without curative expectation.
Measurements And Main Results:
Final pathology reclassified five cases as "mixed intent" due to R0 margins or unexpectedly limited disease burden, while six remained palliative. R0 resection was achieved in 9 of 11 patients; one had no residual tumor, and one had microscopic residual disease. Median estimated blood loss was 350 mL. Postoperative complications occurred in 63.6% of patients, with three reoperations, and there was no intraoperative or 30-day mortality. Readmissions occurred in 54.5% of patients. Local recurrence was observed in 45.5%, and three patients received postoperative adjuvant therapy. Overall survival was 100% at 6 months and 83.3% (95% CI 27.3 to 97.5) at 12 months, based on a single death.
Conclusion:
Further research is needed to evaluate long-term outcomes and quality of life in this population. Robotic-assisted pelvic exenteration is technically feasible in this highly selected palliative cohort. Perioperative morbidity was substantial, although within the range reported for pelvic exenteration4,23. No standardized symptom or quality-of-life instrument was applied, so symptomatic benefit cannot be inferred. The survival estimate rests on a single death with a wide confidence interval and is exploratory; median overall survival was not reached. The R0 rate raises the possibility that curative potential is underestimated preoperatively in some patients, but the small sample, retrospective design, and post hoc reclassification of intent require careful interpretation. Prospective evaluation of long-term outcomes and quality of life is needed.