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Multicenter Study
. 2025 Dec 1;282(6):1118-1126.
doi: 10.1097/SLA.0000000000006348. Epub 2024 May 15.

Defining Benchmarks for Pelvic Exenteration Surgery: A Multicentre Analysis of Patients With Locally Advanced and Recurrent Rectal Cancers

Kilian G M Brown  1 , Michael J Solomon  1 , Cherry E Koh  1 , Paul A Sutton  2 , Samuel Aguiar Jr  3 , Tiago S Bezerra  3 , Hamish W Clouston  2 , Ashwin Desouza  4 , Eric J Dozois  5 , Amanda L Ersryd  6 , Frank Frizelle  7 , Jonas A Funder  8 , Julio Garcia-Aguilar  9 , Richard Garfinkle  5 , Tamara Glyn  7 , Alexander Heriot  10 , Yukihide Kanemitsu  11 , Chia Y Kong  12 , Helle Ø Kristensen  13 , Songphol Malakorn  14 , David M Mens  15 , Per J Nilsson  16 , Gabriella J Palmer  16 , Emmanouil Pappou  9 , Martha Quinn  12 , Aaron J Quyn  17 , Chucheep Sahakitrungruang  14 , Avanish Saklani  4 , Arne M Solbakken  6 , Jim P Tiernan  17 , Cornelis Verhoef  15 , Daniel Steffens  1
Affiliations
Multicenter Study

Defining Benchmarks for Pelvic Exenteration Surgery: A Multicentre Analysis of Patients With Locally Advanced and Recurrent Rectal Cancers

Kilian G M Brown et al. Ann Surg. .

Abstract

Objective: To establish globally applicable benchmark outcomes for pelvic exenteration (PE) in patients with locally advanced primary rectal cancer (LARC) and locally recurrent rectal cancer (LRRC), using outcomes achieved at highly specialised centres.

Background: PE is established as the standard of care for selected patients with LARC and LRRC. There are currently no available benchmarks against which surgical performance in PE can be compared for audit and quality improvement.

Methods: This international multicentre retrospective cohort study included patients undergoing PE for LARC or LRRC at 16 highly experienced centres between 2018 and 2023. Ten outcome benchmarks were established in a lower-risk subgroup. Benchmarks were defined by the 75th percentile of the results achieved at the individual centres.

Results: Seven hundred sixty-three patients underwent PE, of which 464 patients (61%) had LARCs and 299 (39%) had LRRCs. Five hundred forty-four patients (71%) who met predefined lower-risk criteria formed the benchmark cohort. For patients with LARC, the calculated benchmark threshold for major complication rate was ≤44%; Comprehensive Complication Index: ≤30.2; 30-day mortality rate: 0%; 90-day mortality rate: ≤4.3%; R0 resection rate: ≥79%. For patients with LRRC, the calculated benchmark threshold for major complication rate was ≤53%; Comprehensive Complication Index: ≤34.1; 30-day mortality rate: 0%; 90-day mortality rate: ≤6%; R0 resection rate: ≥77%.

Conclusions: The reported benchmarks for PE in patients with LARC and LRRC represent the best available care for this patient group globally and can be used for rigorous assessment of surgical quality and to facilitate quality improvement initiatives at international exenteration centres.

Keywords: benchmarking; locally advanced rectal cancer; locally recurrent rectal cancer; pelvic exenteration; surgical outcomes.

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Conflict of interest statement

J.G.A.—Ethicon (Professional Services and Activities) and Intuitive Surgical Inc. Equity (Professional Services and Activities). The remaining authors report no conflicts of interest.

References

    1. Solomon MJ, Brown KGM. Extended radical resection: the standard of care for patients with advanced pelvic malignancy. Ann Surg Oncol. 2020;27:323–324.
    1. 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;22:835–845.
    1. Steffens D, Solomon MJ, Young JM, et al. Cohort study of long-term survival and quality of life following pelvic exenteration. BJS Open. 2018;2:328–335.
    1. Bhangu A, Ali SM, Darzi A, et al. Meta-analysis of survival based on resection margin status following surgery for recurrent rectal cancer. Colorectal Dis. 2012;14:1457–1466.
    1. Brown KGM, Solomon MJ, Sutton PA, et al. The definition of clear resection margins in locally recurrent rectal cancer—time for consensus. Br J Surg. 2024;111:znad450.

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