Optimizing Outcomes in Pelvic Exenteration Surgery for Advanced Pelvic Malignancies

Pelvic exenteration refers to the en-bloc resection of pelvic organs that cross embryological and standard oncological planes, and is usually performed as part of the management of locally-advanced primary or recurrent malignancy. Given its complexity, associated morbidity and historically poor oncological outcomes, the practice did not gain widespread acceptance until the turn of the millennium. Over the last few decades, pelvic exenteration surgery has greatly evolved: multidisciplinary teams have been able to undertake increasingly extended resections, all while perioperative care has improved with a focus on both oncological outcomes and quality of life. Pelvic exenteration now represents the standard of care for patients with locally-advanced primary and recurrent rectal cancer, and is utilized for numerous other pelvic malignancies as well. With improvements in systemic therapy and better control of distant metastatic disease, the indications for pelvic exenteration are likely to further expand. This changing landscape has ultimately resulted in an increase in research on pelvic exenteration to better inform evidence-based practice and serve this patient population.

The pioneering period of the 1990s and 2000s, where demonstration of safety and oncological feasibility of exenterative surgery was the priority, is now well behind us. The focus of academic referral units is now on optimizing patient selection and outcomes in the pursuit of excellence. Despite the increased recognition of pelvic exenteration for locally-advanced pelvic malignancies, there is still unwarranted variation in the definitions, indications, and outcomes across institutions. Moreover, there are several controversies and unanswered questions that warrant further investigation. The goal of this Research Topic is to generate new data and perspectives in the use of pelvic exenteration surgery for locally-advanced primary or recurrent pelvic malignancies. Through original research and/or data synthesis, new evidence-based practices can be implemented to optimize outcomes for patients with complex pelvic tumors.

We welcome Original Research, Review, Mini Review and Perspective articles on themes including, but not limited to:

• Minimally-invasive approaches to pelvic exenteration

• Neoadjuvant treatment strategies

• Preoperative optimization / prehablitation

• Team-based approach including multidisciplinary teams review, operative planning and intraoperative teamwork

• Technical considerations (e.g., different reconstruction methods) to reduce postoperative morbidity

• Volume-outcome relationships and benchmarking outcomes for pelvic exenteration

• Patient-reported outcomes and functional recovery after pelvic exenteration

• Consensus definitions and terminology for pelvic exenteration

• The development of exenteration programs

• Use of imaging, radiomics and other biomarkers in patient assessment and selection

• The role of artificial intelligence in optimizing perioperative care

Please note: Manuscripts consisting solely of bioinformatics, computational analysis, or predictions of public databases which are not accompanied by validation (independent clinical or patient cohort, or biological validation in vitro or in vivo, which are not based on public databases) are not suitable for publication in this journal.

Keywords: pelvic exenteration, oncologic surgery, malignancies, treatment strategies, perioperative care

Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.