AB112. SOH26AB_0413. Pelvic exenteration for colorectal cancer: contemporary outcomes from a high-volume Irish centre

Background: International multicentre data show a shift towards more radical pelvic exenteration for locally advanced and recurrent rectal cancer, including increased rates of bone resection and flap reconstruction, with improved R0 rates and stable morbidity. This study aimed to evaluate local practice and compare outcomes with modern international benchmarks.

Methods: A retrospective review was performed of all pelvic exenterations between January 2020 and October 2025 at St. Vincent’s University Hospital. Demographic, oncological, operative, and perioperative data were collected, with detailed analysis of cases performed for colorectal malignancy.

Results: Among 136 pelvic exenterations, 63% were performed for urological malignancy, and 25.7% were for colorectal cancers. The remainder were for gynaecological, sarcoma, or complex benign pathology. In the colorectal cohort, 78.8% had locally advanced disease, and 22.2% recurrent disease. Total pelvic exenteration was required in 27.3%, with 33% undergoing urinary reconstruction, 6% pelvic side wall dissection, and 3% flap reconstruction of a perineal defect. Median length of stay was 12 (range, 9–20) days, and 25% experienced 30-day post-operative morbidity. A negative resection margin was achieved in 91.7% and 71.4% of locally advanced and recurrent cases.

Conclusions: Local data compares favourably to international multicentre outcomes, with high rates of R0 resection with comparatively lower use of flap reconstruction and bone resection and no excess morbidity. These findings suggest that a selective, less aggressive approach can achieve excellent oncological outcomes in appropriate patients.

Keywords: Colorectal cancer; morbidity; pelvic exenteration; selective surgical approach; R0 resection