Impact of Pre-Operative Nutritional Status on Postoperative Outcomes Following Pelvic Exenteration: A Systematic Review and Meta-Analysis.

BACKGROUND

Pelvic exenteration is an extensive procedure for advanced or recurrent pelvic malignancies, associated with high morbidity and mortality. Malnutrition is common in this cohort and may affect postoperative outcomes, but the current evidence remains inconsistent.

MATERIALS AND

METHODS

A systematic review was performed following PRISMA guidelines. Pooled analyses were used to assess the relationship between preoperative nutritional status (serum albumin, BMI, and Subjective Global Assessment (SGA)) and postoperative outcomes, with results shown as odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Nine retrospective cohorts comprising 1057 patients were included. The median age across studies was 56 years. Primary tumour types included colorectal, gynaecological, bladder, and soft tissue sarcoma. All studies reported complications, most of which were classified using the Clavien-Dindo system. Low BMI was linked to increased postoperative morbidity (OR 1.12, 95% CI 1.02-1.23, *p = 0.02). Hypoalbuminemia (< 35 g/L) (OR 1.38, 95% CI 0.62-3.08, p = 0.44) and SGA-defined malnutrition (OR 1.24, 95% CI 0.24-6.48, p = 0.09) showed non-significant but consistent trends towards higher complications in malnourished patients. Secondary outcomes were statistically significant, with malnourished patients experiencing longer hospital stays (SMD 0.44, 95% CI 0.26-0.62, *p < 0.00001) and more reoperations (OR 1.82, 95% CI 1.08-3.09, *p = 0.03).

CONCLUSION

Pre-operative malnutrition is linked to increased morbidity after pelvic exenteration. Low BMI was associated with increased postoperative morbidity following pelvic exenteration, while hypoalbuminaemia and SGA-defined malnutrition demonstrated consistent but non-significant associations. These findings support routine nutritional screening and preoperative optimisation in this high-risk patient group.