Conventional versus high-complexity total pelvic exenteration for locally advanced and locally recurrent rectal cancer: an international multicenter study
Garrett, C. Brown, K. G. M. Solomon, M. J. Sutton, P. A. Koh, C. E. Aguiar, S., Jr. Bezerra, T. S. Clouston, H. W. Desouza, A. L. Dozois, E. J.
Garrett, C.
Brown, K. G. M.
Solomon, M. J.
Sutton, P. A.
Koh, C. E.
Aguiar, S., Jr.
Bezerra, T. S.
Clouston, H. W.
Desouza, A. L.
Dozois, E. J.
Abstract
BACKGROUND: Pelvic exenteration is the treatment of choice for selected patients with locally advanced primary and recurrent rectal cancer. Involvement of major pelvic neurovascular structures and bone was historically considered a contraindication due to unacceptably high rates of morbidity and low R0 resection rates. OBJECTIVE: To compare the outcomes of these"high-complexity" exenterative resections to those of"conventional" pelvic exenteration. DESIGN: International multicenter retrospective cohort study. SETTINGS: Sixteen specialized exenteration centers. PATIENTS: Those who underwent total pelvic exenteration for locally advanced primary and recurrent rectal cancer between 2018 and 2023 at participating centers. MAIN OUTCOME MEASURES: Perioperative resource utilization, morbidity, mortality, and R0 resection rates were reported. RESULTS: Seven hundred sixty-three patients underwent total pelvic exenteration, of whom 478 (63%) and 285 (37%) required conventional and high-complexity procedures, respectively. High-complexity pelvic exenteration was associated with longer operating time (600 vs 480 minutes, p < 0.001 for locally advanced primary rectal cancer, 623 vs 480 minutes, p < 0.001 for locally recurrent rectal cancer), intensive care stay (2 vs 1 day, p < 0.001 and 3 vs 1 day, p < 0.001), hospital stay (19 vs 15 days, p = 0.008 and 23 vs 15 days, p < 0.001), and higher blood loss (2000 vs 1236 mL, p < 0.001 and 3000 vs 1600 mL, p < 0.001). Morbidity and mortality outcomes and R0 resection rates were similar between the groups. LIMITATIONS: Generalizability of findings outside of expert units. CONCLUSIONS: High-complexity pelvic exenteration for the treatment of rectal cancer is associated with similar morbidity, mortality, and R0 resection rates, but it has a significantly higher operative time, blood loss, and hospital resource utilization compared to conventional pelvic exenteration. In high-volume, specialized centers, these techniques are considered the standard of care for appropriately selected patients with tumors that involve major pelvic bone or neurovascular structures.
Authors
Garrett, C.
Brown, K. G. M.
Solomon, M. J.
Sutton, P. A.
Koh, C. E.
Aguiar, S., Jr.
Bezerra, T. S.
Clouston, H. W.
Desouza, A. L.
Dozois, E. J.
Ersryd, A. L.
Frizelle, F. A.
Funder, J. A.
Garcia-Aguilar, J.
Garfinkle, R.
Glyn, T.
Heriot, A.
Kanemitsu, Y.
Kong, C. Y.
Kristensen, H. O.
Malakorn, S.
Mens, D. M.
Nilsson, P. J.
Palmer, G. J.
Pappou, E.
Quinn, M. M.
Quyn, A. J.
Sahakitrungruang, C.
Saklani, A.
Solbakken, A. M.
Tiernan, J. P.
Verhoef, C.
Steffens, D.
Brown, K. G. M.
Solomon, M. J.
Sutton, P. A.
Koh, C. E.
Aguiar, S., Jr.
Bezerra, T. S.
Clouston, H. W.
Desouza, A. L.
Dozois, E. J.
Ersryd, A. L.
Frizelle, F. A.
Funder, J. A.
Garcia-Aguilar, J.
Garfinkle, R.
Glyn, T.
Heriot, A.
Kanemitsu, Y.
Kong, C. Y.
Kristensen, H. O.
Malakorn, S.
Mens, D. M.
Nilsson, P. J.
Palmer, G. J.
Pappou, E.
Quinn, M. M.
Quyn, A. J.
Sahakitrungruang, C.
Saklani, A.
Solbakken, A. M.
Tiernan, J. P.
Verhoef, C.
Steffens, D.
Description
Date
2026
Publisher
Collections
Keywords
Type
Article
Citation
Garrett C, Brown KGM, Solomon MJ, Sutton PA, Koh CE, Aguiar S, Jr., et al. Conventional versus high-complexity total pelvic exenteration for locally advanced and locally recurrent rectal cancer: an international multicenter study. Diseases of the Colon & Rectum. 2026 JAN;69(1):34-41.