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Peer-reviewedCC BY-NC-ND 4.0In Vivo

Six Decades of Pelvic Exenterative Surgery for Gynaecological Malignancies: A Meta-analysis of Indications and Surgical Outcomes in 13,434 Cases Across 29 Countries

  • MICHAIL SIDERIS1,2
  • CHIARA CARICATO2,3,4
  • AMANDA DIBDEN2
  • ALEXANDRA NYIRO1
  • BETHANY WILDRIDGE1
  • KSHITIJ JAMDADE5
  • VENSHANI DE ALWIS1
  • NANA GOMES1
  • LILI ELLISON1,2
  • SAVVAS PAPAGRIGORIADIS6
  • NIKOLAOS LYMPEROPOULOS7
  • OLEG BLYUSS2,8
6 more authors
  • ELLY BROCKBANK1
  • ARJUN JEYARAJAH1
  • ANNA FAGOTTI3,4
  • CLAUDIA MARCHETTI3,4
  • SAURABH PHADNIS1
  • RANJIT MANCHANDA1,2,9
9 affiliations
  1. 1Department of Gynaecological Oncology, The Royal London Hospital, Barts Health NHS Trust, London, U.K.
  2. 2Wolfson Institute of Population Health, Queen Mary University of London, London, U.K.
  3. 3Institute of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy
  4. 4Department of Women’s, Children’s and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
  5. 5Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, U.K.
  6. 6IASO General Hospital, Athens, Greece
  7. 7Department of Plastic Surgery, Pinderfields Hospital, The Mid Yorkshire Teaching Hospitals NHS Trust, Yorkshire, U.K.
  8. 8Department of Pediatrics and Pediatric Infectious Diseases, Institute of Child’s Health, Moscow, Russian Federation
  9. 9Department of Health Services Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, U.K.
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Abstract

Background/Aim: Robust international data on pelvic exenteration (PE) are limited. This study aimed to summarise indications, intent, surgical outcomes, morbidity, and mortality of PE for gynaecological malignancies.

Materials and Methods: PubMed was searched from inception to November 2024 (PROSPERO CRD42024615187) following PRISMA guidelines. Data on histology, demographics, body mass index, PE type and intent, prior radiotherapy, resection margins, operative time, hospital stay, and Clavien-Dindo (CD) morbidity/mortality were extracted. Random-effects meta-analysis estimated pooled proportions with 95% confidence intervals (95%CI). Exploratory subgroup analyses compared pre- versus post-2005 studies and regions. Study quality was assessed using MINORS.

Results: We included 132 studies comprising 13,434 women. Pooled proportions of anterior, posterior, and total PE were 33%, 19%, and 49%, respectively. Indications were cervical (61%), uterine (13%), vulval (13%), and vaginal/other malignancies (17%). PE was performed for recurrent disease in 68%, and negative margins were achieved in 76%. Pooled CD grade I-IV complication rates were 21%, 38%, 28%, and 10%, respectively; 30-day mortality was 5%. From pre- to post-2005 studies, cervical indications declined from 76.1% to 61.0% (p=0.008), uterine indications increased from 3.0% to 12.4% (p<0.001), and mortality decreased from 8.1% to 3.7% (p<0.001). Mortality was 4.5% in Europe, 5.9% in the US, and 11.4% in Latin America (p<0.001).

Conclusion: PE carries substantial morbidity, while perioperative mortality was approximately 5% overall and 3.7% in post-2005 studies. Given substantial heterogeneity, pooled estimates should be interpreted as broad descriptive summaries rather than universal benchmarks.

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Cite

BibTeXRIS
BibTeX
@article{sideris2026decades,
  title = {{Six Decades of Pelvic Exenterative Surgery for Gynaecological Malignancies: A Meta-analysis of Indications and Surgical Outcomes in 13,434 Cases Across 29 Countries}},
  author = {MICHAIL SIDERIS and CHIARA CARICATO and AMANDA DIBDEN and ALEXANDRA NYIRO and BETHANY WILDRIDGE and KSHITIJ JAMDADE and VENSHANI DE ALWIS and NANA GOMES and LILI ELLISON and SAVVAS PAPAGRIGORIADIS and NIKOLAOS LYMPEROPOULOS and OLEG BLYUSS and ELLY BROCKBANK and ARJUN JEYARAJAH and ANNA FAGOTTI and CLAUDIA MARCHETTI and SAURABH PHADNIS and RANJIT MANCHANDA},
  journal = {In Vivo},
  year = {2026},
  month = oct,
  doi = {10.21873/invivo.14476},
  url = {https://doi.org/10.21873/invivo.14476},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Six Decades of Pelvic Exenterative Surgery for Gynaecological Malignancies: A Meta-analysis of Indications and Surgical Outcomes in 13,434 Cases Across 29 Countries
AU  - MICHAIL SIDERIS
AU  - CHIARA CARICATO
AU  - AMANDA DIBDEN
AU  - ALEXANDRA NYIRO
AU  - BETHANY WILDRIDGE
AU  - KSHITIJ JAMDADE
AU  - VENSHANI DE ALWIS
AU  - NANA GOMES
AU  - LILI ELLISON
AU  - SAVVAS PAPAGRIGORIADIS
AU  - NIKOLAOS LYMPEROPOULOS
AU  - OLEG BLYUSS
AU  - ELLY BROCKBANK
AU  - ARJUN JEYARAJAH
AU  - ANNA FAGOTTI
AU  - CLAUDIA MARCHETTI
AU  - SAURABH PHADNIS
AU  - RANJIT MANCHANDA
PY  - 2026
DA  - 2026/10/29
JO  - In Vivo
DO  - 10.21873/invivo.14476
UR  - https://doi.org/10.21873/invivo.14476
AB  - Background/Aim: Robust international data on pelvic exenteration (PE) are limited. This study aimed to summarise indications, intent, surgical outcomes, morbidity, and mortality of PE for gynaecological malignancies.  Materials and Methods: PubMed was searched from inception to November 2024 (PROSPERO CRD42024615187) following PRISMA guidelines. Data on histology, demographics, body mass index, PE type and intent, prior radiotherapy, resection margins, operative time, hospital stay, and Clavien-Dindo (CD) morbidity/mortality were extracted. Random-effects meta-analysis estimated pooled proportions with 95% confidence intervals (95%CI). Exploratory subgroup analyses compared pre- versus post-2005 studies and regions. Study quality was assessed using MINORS.  Results: We included 132 studies comprising 13,434 women. Pooled proportions of anterior, posterior, and total PE were 33%, 19%, and 49%, respectively. Indications were cervical (61%), uterine (13%), vulval (13%), and vaginal/other malignancies (17%). PE was performed for recurrent disease in 68%, and negative margins were achieved in 76%. Pooled CD grade I-IV complication rates were 21%, 38%, 28%, and 10%, respectively; 30-day mortality was 5%. From pre- to post-2005 studies, cervical indications declined from 76.1% to 61.0% (p=0.008), uterine indications increased from 3.0% to 12.4% (p<0.001), and mortality decreased from 8.1% to 3.7% (p<0.001). Mortality was 4.5% in Europe, 5.9% in the US, and 11.4% in Latin America (p<0.001).  Conclusion: PE carries substantial morbidity, while perioperative mortality was approximately 5% overall and 3.7% in post-2005 studies. Given substantial heterogeneity, pooled estimates should be interpreted as broad descriptive summaries rather than universal benchmarks.
SN  - 0258-851X
SN  - 1791-7549
ER  -