EP148 - Implementing a Pelvic Exenterative Service for Locally Advanced and Recurrent Rectal Cancer in the Greek National Health System

Saturday, May 10, 2025

3:25 PM – 3:30 PM PT

Location: Monitor 7, Sails Pavilion, Upper Level

ePoster Presenter(s)

Stavroula Papaeleftheriou, MD (she/her/hers)

Surgical Resident
General Hospital of Athens "Evaggelismos"
Athens, Attiki, Greece

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

KB

Konstantinos Bikas, MD

Surgical Resident
General Hospital of Athens "Evaggelismos"
Athens, Attiki, Greece

Disclosure information not submitted.
VT

Vasiliki Tseliou, MD

Surgical Resident
General Hospital of Athens "Evaggelismos"
Athens, Attiki, Greece

Disclosure information not submitted.
SK

Stavroula Katsimente, MD

Surgical Resident
General Hospital of Athens "Evaggelismos"
Athens, Attiki, Greece

Disclosure information not submitted.
DM

Dimitrios Matsagkos, MD

Surgical Resident
General Hospital of Athens "Evaggelismos"
Athens, Attiki, Greece

Disclosure information not submitted.
ML

Marietta Lavrentaki, MD

Surgical Resident
General Hospital of Athens "Evaggelismos"
Athens, Attiki, Greece

Disclosure information not submitted.
AC

Athina Chrysikopoulou, MD

Surgical Resident
General Hospital of Athens "Evaggelismos"
Athens, Attiki, Greece

Disclosure information not submitted.
GG

Giorgos Giannos, MD

Surgical Resident
General Hospital of Athens "Evaggelismos"
Athens, Attiki, Greece

Disclosure information not submitted.
TB

Teresa Bidetti, MD

Surgical Resident
General Hospital of Athens "Evaggelismos"
Athens, Attiki, Greece

Disclosure information not submitted.
AS

Aikaterini Starka, MD

Surgical Resident
General Hospital of Athens "Evaggelismos"
Athens, Attiki, Greece

Disclosure information not submitted.
AK

Aggeliki Koltsida, MD

Surgical Resident
General Hospital of Athens "Evaggelismos"
Athens, Attiki, Greece

Disclosure information not submitted.
GT

Giorgos Taimpiris, MD

Surgical Resident
General Hospital of Athens "Evaggelismos"
Athens, Attiki, Greece

Disclosure information not submitted.

Senior Author(s)

CK

Christos Kontovounisios, MD, PhD, FACS, FRCS

Surgeon, Head of Surgery at 2nd Surgical Department
General Hospital of Athens "Evaggelismos"
Athens, Attiki, Greece

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Stavroula Papaeleftheriou, MD: This individual has no financial relationships with ineligible companies.

Christos Kontovounisios, MD, PhD, FACS, FRCS: This individual has no financial relationships with ineligible companies.

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Purpose/Background: Pelvic exenteration (PE) is the surgery of choice for the management of locally-advanced primary and recurrent pelvic cancers. PE service requires a multidisciplinary approach by a variety of specialties. Selection process, decision making and surgical technique are the key pillars resulting in better patient outcomes. However sustaining and implementing a new demanding service such as PE in a National Health System it requires to incorporate both objectively in terms of survival, and subjectively in terms of quality of life and health economics key performance indicators. We present the current landscape, challenges and obstacles of implementing a PE service in the largest tertiary hospital in the Greek National Health System.

Methods/Interventions: National Snapshot Survey disseminated through the Greek Surgical Societies in order to capture the current peri-operative management for Locally Advanced Rectal Cancer ( LARC) & Recurrent Rectal Cancer ( RRC). Analysis of PE performed in a newly developed unit in a tertiary hospital from April 2024 to October 2024.

Results/Outcomes: Most respondents were surgeons, 22% of whom had received fellowships in pelvic exenteration surgery. 83% of the participants reported holding multidisciplinary team meetings, and typically fewer than 10 pelvic exenteration procedures are conducted annually. Twenty-eight percent of the participants, employ a validated classification system to describe the operative approach (Pelvic Exenteration Lexicon). Considering outcomes, surgical factors like length of stay (78%), blood loss, ICU duration (72%), blood loss (70%) and number of blood transfusions (64%) were prioritized, whereas patient-reported outcomes focused on physical functioning (77%), quality of life (75%), and urinary function (75%). For urological reconstructions, percutaneous nephrostomy (87%), cutaneous ureterostomy (75%) and urinary diversion using an ileal conduit (73%) were utilized the most, while plastic reconstructions involved mainly mesh placement (72%), omental flap with/without a skin graft (70%) and pedicled flaps (58%). Most prevalent complications were perineal wound dehiscence, abdominal wall hernia, postoperative ileus, urinary infection and VTE.
Five patients had total pelvic exenteration (TPE), three of them combined with sacrectomy , one had HISS and ELSIE. We had no major morbidity. Two of 5 patients who survived the immediate postoperative period have relapsed. R0 resection was achieved in 80 %. All the patients were presented with RRC.

Conclusion/Discussion: Implementing a newly developed PE service is feasible with state of art good outcomes, financially sustainable under a multidisciplinary team based mentality. Adding collaboration, teaching and research opportunities to the ‘one-third selection process, one third decision-making and one-third surgical technique’ trio will allow specialist surgeons to practice more precision surgery in dedicated institutions, equipped with state-of-the-art technology providing compassionate care through a clinical approach based on direct personal interaction with patients.