Pelvic exenteration for locally advanced and recurrent rectal cancer—how much more?

The management of patients with locally advanced or recurrent rectal cancer has evolved dramatically in recent decades (1). Although total pelvic exenteration (PE) was originally performed in the 1940s as a palliative procedure in an attempt to improve the quality of life of patients with advanced cervical cancer, it now represents the treatment of choice for patients with advanced or recurrent rectal cancer, and the only potentially curative option in a group who would otherwise be palliated. While rates of postoperative morbidity and mortality were initially high, surgical technique and patient selection has been refined, and imaging and radiation technology has advanced. As a result, PE is now performed routinely at specialised centres, offering patients a chance of long-term survival with acceptable morbidity and quality of life (2-6)