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. 2025 Nov 28;24(1):2.
doi: 10.1186/s12957-025-04053-0.

Outcomes and survival trends following pelvic exenteration for locally advanced and recurrent rectal cancer: a 20-Year analysis from a tertiary cancer center in India

M D Ray  1 , Amit Kumar  2 , Rohan Kapoor  1
Affiliations

Outcomes and survival trends following pelvic exenteration for locally advanced and recurrent rectal cancer: a 20-Year analysis from a tertiary cancer center in India

M D Ray et al. World J Surg Oncol. .

Abstract

Background: Pelvic exenteration (PE) offers a potential cure for selected patients with Locally Advanced Rectal Cancer (LARC) or Locally Recurrent Rectal Cancer (LRRC) invading adjacent pelvic organs. Despite advances in surgical technique and perioperative care, PE remains associated with significant morbidity. This study evaluates long-term oncologic outcomes of PE over 20 years at a high-volume tertiary cancer center in India.

Methods: We retrospectively analysed 97 patients who underwent PE between January 2000 and December 2020. Patients included those with LARC or LRRC, where R0 resection was deemed feasible. Surgical procedures were classified as total pelvic exenteration (TPE) or modified pelvic exenteration (MPE). Data on demographics, operative parameters, pathological features, recurrence pattern and survival were analysed.

Results: Among the 97 patients (median age 59; 80.4% male), 67% had LARC and 33% LRRC. R0 resection was achieved in 71.1%. TPE was more common in LRRC, while MPE predominated in LARC (p = 0.014). Common complications included pelvic collection (25.8%) and wound infection (15.5%). The 5-year OS was higher in R0 resection patients (51.9% vs. 12.9%; p = 0.013) and those with LARC vs. LRRC (57.0% vs. 10.6%; p = 0.032). LRRC had higher recurrences post R0 resection. In the multivariate analysis, the only independent predictors of OS were the initial presentation of the disease and R0 resection.

Conclusion: PE remains a curative strategy for LARC and LRRC following an R0 resection. LRRC is associated with higher recurrence and poorer survival. Optimal outcomes require multidisciplinary evaluation, margin-negative resection, and tailored surgical approaches. This study provides data from a low- and middle-income country setting, where such literature remains limited.

Keywords: Locally advanced rectal cancer; Locally recurrent rectal cancer; Overall survival; Pelvic exenteration; R0 resection.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study is a retrospective observational analysis of previously recorded clinical data, and no direct patient contact or intervention was involved. As per institutional policy and national guidelines, IEC clearance is not mandatory for retrospective studies using anonymized data. However, all data handling was performed in compliance with ethical standards ensuring patient confidentiality. Consent for publication: Not Applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan–meier curve for overall survival in patients undergoing PE. Figure1A. Kaplan–meier curve for overall survival in the entire cohort Figure1B. Kaplan–meier curves comparing overall survival based on resection margin status
See this image and copyright information in PMC

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