Systemic Inflammation Response Index and primary cancer site predict futility of pelvic exenteration surgery for locally advanced and recurrent pelvic malignancy.

BACKGROUND

Pelvic exenteration (PE) is a major procedure typically performed for patients with locally advanced or recurrent pelvic malignancy. Appropriate patient selection is crucial to achieving good outcomes and obviating futile resections. The objective of this study was to establish the incidence and predictors of futile PE in patients with locally advanced or recurrent pelvic malignancy.

METHODS

A retrospective analysis of a prospective database of patients undergoing PE for advanced or recurrent pelvic malignancy between 2008 and 2025 was performed. Patients with benign disease or less than 6 months' follow-up were excluded, except those who died or recurred within 6 months, who were classified as futile PE. Futility in planned R0 (curative) resections was defined as death from any cause or recurrence (local or distant) within 6 months. Futility in planned R1/R2 (palliative) resections was defined as death from any cause within 6 months. Multivariable logistic regression was performed to identify predictors of futile PE.

RESULTS

Of 224 patients identified, 172 were eligible for inclusion in the study and 25 (14.5 %) patients had a futile resection criteria. Multivariable analysis demonstrated Systemic Inflammation Response Index (SIRI ≥1.92) (OR, 7.06; 95 % CI, 1.58-31.57; P = 0.011) and cancer site (non-colorectal cancer) (OR, 4.68; 95 % CI, 1.81-12.10; P = 0.001) as independent risk factors for futile surgery.

CONCLUSION

Futile PE was observed in 14.5 % of patients. Key predictors of futility included non-colorectal cancers and elevated preoperative SIRI levels.