Clinical Outcomes of Patients Submitted to Pelvic Exenteration With Major Vascular Resection and Reconstruction: A Systematic Review of the Literature.

AIM: The present study aims to evaluate the current data regarding the clinical outcomes of patients undergoing pelvic exenteration with major vascular resection and reconstruction.

METHODS

This study was conducted according to the PRISMA guidelines and the Cochrane handbook. Scholar databases were systematically screened. The last search date was March 2026. The primary endpoint was the overall complications rate. Secondary endpoints included specific postoperative complications, oncological outcomes of interest, and perioperative efficacy metrics. Random Effects (RE) models were reported.

RESULTS

Overall, 6 studies and 69 patients were included in this study. Pooled complications rate was 57.9% (95% CI: 32.2%-83.6%, p = 0.003). Overall vessel thrombosis and reoperation rates were estimated to be 16.5% (p = 0.008) and 21.7% (p = 0.011). The reported reoperated cases included hemostasis n:13, stent placement n:3, thrombectomy n:2, fasciotomies n:2 and amputation n:1. R0 resection margin was achieved in 58.2% (p = 0.002) of patients. It was shown that in cases with a primary tumor R0 rate was 50% (p = 0.295), while in the recurrent malignancies this dropped to 42% (p = 0.364). Two patients had local relapse at 15 and 25 months while distal metastasis related mortality developed in two patients at 14 and 22 months after surgery. In total, the pooled local recurrence rate was 20% (p = 0.002).

CONCLUSION

We estimated a significant overall morbidity burden with increased risk for loss of vascular patency and reoperation and suboptimal oncological outcomes. Despite this, cases with pelvic confined disease that require vascular reconstruction can still be amendable in curative surgery following multidisciplinary assessment.