EP824 - Pelvic Exenteration for Locally Advanced and Recurrent Rectal Cancer: Ten-Year Experience from a Single Referral Center

Monday, May 12, 2025

1:36 PM – 1:41 PM PT

ePoster Presenter(s)

Janyssa Charbonneau, MD (she/her/hers)

General Surgery Resident
Université Laval
Quebec, QC, Canada

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

Senior Author(s)

PB

Philippe Bouchard, MD FRCSC

Colorectal Surgeon and Clinical Professor
CHU de Québec Université Laval
Quebec, Quebec, Canada

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

Author(s)

SD

Sebastien Drolet, MD, FRCSC

Colorectal Surgeon and Clinical Professor
CHU de Québec Université Laval
Quebec, Quebec, Canada

Disclosure information not submitted.
TN

Tassé Nicolas, MD, FRCSC

General Surgeon
Université Laval
Quebec, Quebec, Canada

Disclosure information not submitted.
AB

Alexandre Bouchard, MD, FRCSC

Colorectal Surgeon
CHU de Québec Université Laval
Quebec, Quebec, Canada

Disclosure information not submitted.
FL

François Letarte, MD, MHSc, FRCSC

Colorectal Surgeon
CHU de Québec Université Laval
Quebec, Quebec, Canada

Disclosure information not submitted.
FR

François Rouleau-Fournier, MD, MHSc, FRCSC

Colorectal Surgeon
CHU de Québec Université Laval
Quebec, Quebec, Canada

Disclosure information not submitted.
CT

Claude Thibault, MD, FRCSC

Colorectal Surgeon and Professor of Surgery
CHU de Québec Université Laval
Quebec, Quebec, Canada

Disclosure information not submitted.
XP

Xavier Paré, MD, FRCSC

General Surgeon
Université Laval
St-Georges de Beauce, Quebec, Canada

Disclosure information not submitted.

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

Janyssa Charbonneau, MD: This individual has no financial relationships with ineligible companies.

Philippe Bouchard, MD FRCSC: This individual has no financial relationships with ineligible companies.

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Purpose/Background: Pelvic exenteration is an aggressive surgical approach for the curative treatment of locally advanced and recurrent rectal cancer. This type of en bloc resection is highly variable as it can include a variety of organs. Therefore, the standardization of this procedure and the evaluation of its outcomes are challenging. A R0 margin status has been demonstrated to be a major factor to impact recurrence and survival. However, those reported outcomes are still highly variable in the literature. The aim of this research was to review pelvic exenterations’ oncological outcomes and identify potential key elements for the optimization of locally advanced rectal cancer’s surgical management.

Methods/Interventions: This retrospective study reviewed the experience of a single referral center. All patients who underwent pelvic exenteration from 2009 to 2018 were reviewed. A mandatory preoperative standardized pelvic MRI had been conducted and all cases had been discussed at the institution’s multidisciplinary tumor board for final decisions on preoperative treatments and surgical approach. Outcomes were 5-year overall survival and disease-free survival, resection margins status, morbidity and mortality. Kaplan-Meier curves were performed.

Results/Outcomes: Ultimately, 55 patients were included. The rate of R0 margins was 84%, with 11% and 27% rates of coccygectomy and sacrectomy, and 46% rate of iliac vessels resection. The 5-year overall survival was estimated at 68% and disease-free survival was at 53%. Overall complications rate was 49%, with 9 cases of major complication (Clavien-Dindo III-IV) and no 30-day mortality.

Conclusion/Discussion: Pelvic exenteration can be associated with favorable oncological outcomes for locally advanced diseases. A radical surgical approach involving en bloc iliac vessels and bone resections may help obtain R0 margins. Standardized preoperative MRI and multidisciplinary collaboration are essential elements to include when managing such complex oncological cases.