Eimear Therese Kyle1,2,3, Niall O’Sullivan1,2,3, Hugo Temperley1,2,3, Fariba Tohidinezhad4, Mirac Ajredini5, James Meaney1, Bedirye Koyuncu Sokmen5, Rumeysa Atabey5, Leyla Ozer5, Erman Aytac5, Alison Corr1, Alberto Traverso6, Michael Eamon Kelly2,7,8
1Department of Radiology, St. James’s Hospital, Dublin, Ireland;
2School of Medicine, Trinity College Dublin, Dublin, Ireland;
3Centre for Advanced Medical Imaging (CAMI), St. James’s Hospital, Dublin, Ireland;
4Department of Radiation Oncology (Maastro Clinic), School for Oncology and Reproduction (GROW), Maastricht University Medical Centre, Maastricht, The Netherlands;
5Acibadem University, Atakent Hospital Gastrointestinal Oncology Unit, Istanbul, Turkey;
6School of Medicine, Libera Università Vita-Salute San Raffaele, Milan, Italy;
7Department of Surgery, St. James’s Hospital, Dublin, Ireland;
8Trinity St. James Cancer Institute (TSJCI), St. James’s Hospital, Dublin, Ireland
Background: Pelvic exenteration surgery is increasingly being considered in patients with locally-advanced or recurrent pelvic malignancies, with margin negativity remaining the most important outcome to date.
Methods: This review describes comprehensive surgical techniques and outcomes of complex exenterative procedures involving bone or major neurovascular resections at a tertiary referral centre since the development of a complex pelvic oncology multidisciplinary team (MDT).
Results: Among 31 patients considered for exenteration surgery, 23 were operated on since July 2023. Fourteen cases (61%) were for primary disease, while 9 (39%) were for recurrent disease. The cohort included 16 (70%) rectal cancers, 4 (17%) gynaecological cancers and 3 (13%) anal cancers. Twelve (52%) patients underwent total pelvic exenterations, and 6 (26%) involved bony resections, of which 3 (13%) were at S3 level and above. A robotic approach was employed in 6 (26%) and laparoscopic in 3 (13%) cases. The median age was 60.5 years, with 13 (57%) female patients. R0 resection was achieved in all bony and robotic exenterations, with an overall R0 rate of 92%. Flap reconstruction, most commonly inferior gluteal artery myocutaneous (IGAM), was performed in all but two patients. The median hospital stay was 23 days, with one patient being returned to theatre. There was no 30- or 90-day mortality. Quality-of-life data is pending.
Conclusions: This review highlights the importance of patient selection in achieving optimal outcomes. Having the correct surgical MDT and skillset allows for minimally-invasive surgical techniques to be employed without compromising margins. Future study focusing on patient survivorship and integration of quality-of-life data will highlight the rationale for complex pelvic exenteration surgery.
Keywords: Minimally invasive surgery; multivisceral resection; pelvic exenteration; pelvic cancer; surgical oncology
