Surgical, survival and quality of life outcomes in over 1000 pelvic exenterations: lessons learned from a large Australian case series

Abstract

Background: To determine surgical, survival and quality of life outcomes across different tumour streams and lessons learned over 28 years. Methods: Consecutive patients undergoing pelvic exenteration at a single, high volume, referral hospital, between 1994 and 2022 were included. Patients were grouped according to their tumour type at presentation as follows, advanced primary rectal cancer, other advanced primary malignancy, locally recurrent rectal cancer, other locally recurrent malignancy and non-malignant indications. The main outcomes included, resection margins, postoperative morbidity, long-term overall survival, and quality of life outcomes. Non-parametric statistics and survival analyses were performed to compare outcomes between groups. Results: Of the 1023 pelvic exenterations performed, 981 (95.9%) unique patients were included. Most patients underwent pelvic exenteration due to locally recurrent rectal cancer (N = 321, 32.7%) or advanced primary rectal cancer (N = 286, 29.2%). The rates of clear surgical margins (89.2%; P < 0.001) and 30-days mortality were higher in the advanced primary rectal cancer group (3.2%; P = 0.025). The 5-year overall survival rates were 66.3% in advanced primary rectal cancer and 44.6% in locally recurrent rectal cancer. Quality of life outcomes differed across groups at baseline, but generally had good trajectories thereafter. International benchmarking revelled excellent comparative outcomes. Conclusions: The results of this study demonstrate excellent outcomes overall, but significant differences in surgical, survival and quality of life outcomes across patients undergoing pelvic exenteration due to different tumour streams. The data reported in this manuscript can be utilized by other centres as benchmarking as well as proving both subjective and objective outcome details to support informed decision-making for patients.

Contemporary management of advanced colorectal cancer: the Australian experience

“…However, significant technical advancements in the past two decades, led in many cases by specialist exenteration units in Australia and New Zealand, 4 have dramatically improved the oncological outcomes of this radical procedure. Pelvic exenteration for rectal cancer is now performed routinely and safely at specialist referral centres, with contemporary 5‐year survival rates of 65–75% for primary tumours and 45–53% for recurrent tumours 5,6 . In 2024, pelvic exenteration is considered the standard of care for selected patients with locally advanced and recurrent rectal cancer.…”

Evaluating geographical disparities on clinical outcomes following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

“…The QoL data was measured using the 36-item Short-Form Survey version 2 (SF-36v2) [ 27 ]. The SF-36v2 tool is a reliable and valid tool, which has been extensively used in patients undergoing CRS and HIPEC [ 28 , 29 ]. This QoL data was collected longitudinally at various time points: pre-operatively, prior to discharge and 3, 6 and 12 months after surgery.…”

Variation in outcome measurement and reporting in studies of pelvic exenteration for locally advanced and recurrent rectal cancer: a systematic review

“…With the improved long-term survival and quality of life outcomes after exenterative surgery for locally advanced and recurrent rectal cancer now well documented, there is increasing clinical and academic interest in this ultra-radical surgery [1][2][3]. The increasing number of centres with experience in pelvic exenteration has facilitated international collaborative studies [4][5][6] and meta-analyses [7,8] that aim to provide adequate volumes of data to answer questions about a procedure that remains relatively uncommon even at specialist referral units.…”