A pioneering approach to one of the most challenging operations in cancer surgery could offer a more feasible and successful option for patients with extensive pelvic cancers, according to research published in the journal Colorectal Disease.
The study, co-funded by Bowel Research UK, is the first to report on two-day, two-stage pelvic exenteration – a major operation that involves removing multiple organs to treat advanced or recurrent pelvic cancers. The research demonstrates that this approach is feasible, safe and accepted by patients.
Pelvic exenteration has become increasingly complex, with resections and reconstructive components now including intraoperative radiotherapy. For some patients requiring very high-complexity surgery with multiple resectional and reconstructive components, these procedures have grown too lengthy to safely complete in a single day.
The Southampton Complex Cancer and Exenteration Team compared 27 patients who underwent the split approach with 38 patients who had conventional single-day operations lasting more than 15 hours.
Complete tumour removal with clear margins was achieved in 82% of two-day cases, although this group experienced somewhat longer hospital stays – a median of 37 days compared with 27 days – this difference did not reach statistical significance.
“For some very highly selected patients with high-complexity pelvic cancers, this two-day approach may represent the only option for curative treatment,” said Mr Charles West, researcher at the University of Southampton. Our study is the first to show that staging this surgery over two days is safe for patients, which is a testament to the hard work of the prehabilitation, anaesthetic, theatre, intensive care, and ward teams that have made this possible.”
Pelvic exenteration remains the only curative option for certain extensive pelvic cancers and one of the most demanding procedures in surgical oncology. While the study found the two-day approach feasible and safe, the authors acknowledge that more data is needed from other high-volume centres to refine this approach to be able to offer this surgery to more patients who could benefit from it.