# 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

## TL;DR

This study analyzes 20 years of pelvic exenteration outcomes for rectal cancer in India, showing better survival with R0 resection and LARC cases.

## Contribution

Provides long-term survival data from a low- and middle-income country on pelvic exenteration for rectal cancer.

## Key findings

- R0 resection significantly improves 5-year survival (51.9% vs. 12.9%).
- Locally advanced rectal cancer (LARC) has better survival than locally recurrent rectal cancer (LRRC).
- LRRC is associated with higher recurrence rates after R0 resection.

## Abstract

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.

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.

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.

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.