Outcomes of Pelvic Exenteration in Locally Advanced Colorectal Cancer
Keywords:
Locally advanced colorectal cancer, Pelvic exenteration, Posterior pelvic exenteration, Total pelvic exenteration, Surgical outcomesAbstract
Background: Pelvic exenteration (PE) is a highly complex surgical procedure indicated for selected patients with locally advanced colorectal cancer (LACC) when standard resection cannot achieve negative margins. Data regarding outcomes of PE in general hospitals remain limited. Objective: To evaluate surgical and oncological outcomes of pelvic exenteration in patients with locally advanced colorectal cancer treated at a general surgical hospital. Methods: A retrospective descriptive study [SK1] was conducted including patients with LACC who underwent pelvic exenteration between November 2021 and January 2025. Demographic characteristics, operative details, pathological findings, and postoperative outcomes were analyzed using descriptive statistics. Results: Nine patients were included; six (66.7%) were female, with a mean age of 60.8 ± 7.1 years. Posterior pelvic exenteration (PPE) was performed in six patients and total pelvic exenteration (TPE) in three. The mean operative time was 474 ± 91 minutes, and the mean estimated blood loss was 1,178 ± 554 mL. R0 resection was achieved in eight patients (88.9%). Postoperative complications were limited to surgical site infection in two patients (22.2%). No 30-day mortality was observed. Median length of hospital stay was 13 days (IQR 11–15). At follow-up, overall survival was 77.8%, and disease-free survival among surviving patients was 55.6%. Conclusion: Pelvic exenteration can be safely performed in a general surgical hospital with acceptable morbidity and a high rate of R0 resection. Multidisciplinary collaboration and careful patient selection are essential. Larger studies with longer follow-up are needed to confirm long-term oncological outcomes.
Keywords: Locally advanced colorectal cancer, Pelvic exenteration, Posterior pelvic exenteration, Total pelvic exenteration, Surgical outcomes
References
National Cancer Institute (Thailand). Cancer in Thailand Vol. XI, 2019-2021 [Internet]. Bangkok: National Cancer Institute; 2025 [cited 2026 Jan 13]. Available from: https://www.nci.go.th/th/File_download/Nci%20Cancer%20Registry/Cancer%20in%20Thailand%20Vol.XI.pdf
International Agency for Research on Cancer. Thailand fact sheet: GLOBOCAN 2022 [Internet]. Lyon: World Health Organization; 2024 [cited 2026 Jan 13]. Available from: https://gco.iarc.who.int/media/globocan/factsheets/populations/764-thailand-fact-sheet.pdf
PelvEx Collaborative. Factors affecting outcomes following pelvic exenteration for locally recurrent rectal cancer. Br J Surg 2018;105(6):650-7.
Brunschwig A. Complete excision of pelvic viscera for advanced carcinoma; a one-stage abdominoperineal operation with end colostomy and bilateral ureteral implantation into the colon above the colostomy. Cancer 1948;1(2):177–83.
Thompson JE, Howe CW. Complete pelvic evisceration in the male for complicated carcinoma of the rectum; the use of a defunctionalized, sterilized loop of colon for ureterosigmoid anastomosis. N Engl J Med 1950;242(3):83–6.
Chen HS, Sheen-Chen SM. Total pelvic exenteration for primary local advanced colorectal cancer. World J Surg 2001;25(12):1546–9.
Domes TS, Colquhoun PHD, Taylor B, Izawa JI, Luke PPW. Total pelvic exenteration for rectal cancer: outcomes and prognostic factors. Can J Surg 2011;54(6):387–93.
Yang TX, Morris DL, Chua TC. Pelvic exenteration for rectal cancer: a systematic review. Dis Colon Rectum 2013;56(4):519–31.
Platt E, Dovell G, Smolarek S. Systematic review of outcomes following pelvic exenteration for the treatment of primary and recurrent locally advanced rectal cancer. Tech Coloproctol 2018;22(11):835-45.
Lohsiriwat V, Lohsiriwat D. Comparison of immediate surgical outcomes between posterior pelvic exenteration and standard resection for primary rectal cancer: a matched case-control study. World J Gastroenterol 2008;14(15):2414–7.
Oranratanaphan S, Termrungruanglert W, Sirisabya N. Characteristics of gynecologic oncology patients in King Chulalongkorn Memorial Hospital – complications and outcome of pelvic exenteration. Asian Pac J Cancer Prev 2013;14(4):2529–32.
Thiptanakit C, Chowchankit I, Panya S, Kanjanasilp P, Malakorn S, Pattana-Arun J, et al. Urgent pelvic exenteration: should the indication be extended? Dis Colon Rectum 2018;61(5):561–6.
Sirikurnpiboon S, Harinwan P. Oncologic outcomes of total pelvic exenteration in locally advanced rectal cancer without neoadjuvant treatment: a retrospective cohort study. Thai J Surg 2023;44(2):61–7.
