Application value of refined surgical classification in pelvic exenteration for locally advanced/recurrent rectal cancer
TAO Yu
LU Yao
ZHANG Ruo-Xin
PENG Huan
WANG Zhi-Guo
SU Ning
SHAO Guo-Yi
ZHOU Hai-Yang
ZHANG Jian
Abstract：Objective To establish a refined surgical classification for pelvic exenteration(PE)based on pelvic anatomical layers,in order to standardize and optimize the operative management of locally advanced rectal cancer(LARC)and locally recurrent rectal cancer(LRRC).Methods In this prospective descriptive case series,200 consecutive patients with LARC or LRRC who underwent PE between January 2023 and December 31,2024 were enrolled from the China Pelvic Exenteration Database.According to pelvic fascial anatomical planes,PE was classified into intra-pelvic PE and combined pelvic wall PE;the latter was further subdivided into lateral pelvic,pelvic floor,posterior pelvic wall and anterior pelvic wall subtypes,each defined by resection of＞50％of the relevant organs or tissues.Primary endpoints included operative time,intraoperative blood loss and postoperative complications graded by the Clavien-Dindo classification;comparative analyses were performed across PE subtypes.Results R0 resection rates were 96.3％for LARC and 71.7％for LRRC.Among all patients,proportions of intra-pelvic PE,lateral pelvic,pelvic floor,posterior pelvic wall and anterior pelvic wall resections were 96％,82％,71.5％,17％and 12％,respectively.Biological mesh isolation for abdominopelvic repair was performed in 98％of cases,and omental flap combined with biological mesh reconstruction in 65％.The overall incidence of severe postoperative complications(Clavien-Dindo grade ≥ Ⅲ b)was 38.8％,with perineal wound healing failure in 18.5％.In the combined pelvic wall PE subgroup,the pelvic floor group exhibited the highest rate of severe complications(33.3％for LARC and 38.5％for LRRC,both P＜0.05);within the LRRC cohort,the lateral pelvic group showed significantly longer operative times and greater blood loss compared to other subgroups(both P＜0.05).Conclusion This anatomically based classification enables precise preoperative assessment of resection extent,improvement of R0 resection rates,evaluation of surgical difficulty and tailored reconstruction planning.Lateral pelvic involvement,particularly with prior radiotherapy,poses the greatest technical challenge,while pelvic floor involvement correlates strongly with severe postoperative complications.Adoption of this scheme may promote standardization of PE procedures and enhance perioperative management;further studies are needed to assess its impact on long-term survival and quality of life.
Keywords：pelvic exenterationsurgical classificationlocally advanced/recurrent rectal cancerperioperative complications
Publication Date：2025-06-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：8( 683-690 )