Contemporary Management of Locally Advanced and Recurrent Rectal Cancer: Views from the PelvEx Collaborative

SIMPLE SUMMARY: Pelvic exenteration is a complex procedure performed for the management of advanced pelvic cancers. It often involves the resection of several pelvic organs and can be associated with a high morbidity and impact on the patient’s quality of life. The development of better diagnostics, improved chemotherapy and radiotherapy regimens, combined with advanced surgical strategies have improved surgical and survival outcomes. This article highlights current and future management options. ABSTRACT: Pelvic exenteration is a complex operation performed for locally advanced and recurrent pelvic cancers. The goal of surgery is to achieve clear margins, therefore identifying adjacent or involved organs, bone, muscle, nerves and/or vascular structures that may need resection. While these extensive resections are potentially curative, they can be associated with substantial morbidity. Recently, there has been a move to centralize care to specialized units, as this facilitates better multidisciplinary care input. Advancements in pelvic oncology and surgical innovation have redefined the boundaries of pelvic exenterative surgery. Combined with improved neoadjuvant therapies, advances in diagnostics, and better reconstructive techniques have provided quicker recovery and better quality of life outcomes, with improved survival This article provides highlights of the current management of advanced pelvic cancers in terms of surgical strategy and potential future developments.