Skip to main content
2026 ASCRS Annual Scientific Meeting Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
CME
CME
Invitation/Ticketed Event
Invitation/Ticketed Event
Invited Lectureship
Invited Lectureship
Award Recipient
Award Recipient
Live Streamed Session
Live Streamed Session
Nurses Contact Hours
Nurses Contact Hours
Self-Assessment
Self-Assessment
Live Q&A and Polling
Live Q&A and Polling
Social
Social
Industry
Industry

Session:: ePoster of Distinction: Colon Cancer

EPD405 - Multi-institutional surgical and oncological outcomes of rectal cancer patients undergoing conventional versus high-complexity total pelvic exenteration

Monday, May 11, 2026
1:52 PM - 1:57 PM ET

    ePoster of Distinction Presenter(s)

  • Richard Garfinkle, MD, MSc, PhD

    Colon and Rectal Surgery
    Jewish General Hospital, McGill University
    Jewish General Hospital, McGill University
    Montreal, QC, Canada

    Disclosure information not submitted.

    • Author(s)

  • CG

    Celine Garrett, MBBS (Hons), MPhil (she/her/hers)

    General Surgery Registrar
    Royal Prince Alfred Hospital
    Sydney, New South Wales, Australia

    Disclosure information not submitted.

    • Author(s)

  • KB

    Kilian Brown, MBBS, BBiomed, MPhil

    Royal Prince Alfred Hospital

    Disclosure information not submitted.

  • PS

    Paul A. Sutton, Phd FRCS

    Consultant Surgeon
    The Christie Hospital
    Manchester, England, United Kingdom

    Disclosure information not submitted.

  • MS

    Michael Solomon, MB BCH (Hons) | BAO | MSc (Tor) | DMedSc (USYD) | DMed (NUI) | FRCSI | FRACS | FASCRS | LRCPI

    Professor of Surgical Research
    University of Sydney
    Sydney, New South Wales, Australia

    Disclosure information not submitted.

  • CK

    Cherry Koh, MBBS (Hons), PhD, FRACS

    Colorectal surgeon
    Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Australia
    Sydney, New South Wales, Australia

    Disclosure information not submitted.

  • SA

    Samuel Aguiar, Jr., M.D.; PhD

    Head of Colorectal/Sarcoma Unit
    A.C. Camargo Cancer Canter
    Sao Paulo, Sao Paulo, Brazil

    Disclosure information not submitted.

  • TB

    Tiago Santoro Bezerra, Dr, MD MSc

    Assistant oncological surgeon
    A.C. Camargo Cancer Center
    São Paulo, Sao Paulo, Brazil

    Disclosure information not submitted.

  • HC

    Hamish W. Clouston, FRCS, MD

    Consultant Surgeon
    The Christie NHS Foundation Trust
    Manchester, England, United Kingdom

    Disclosure information not submitted.

  • AD

    Ashwin Desouza, MCh, MS, MRCSEd, DNB, FCPS, MNAMS

    Professor & Surgeon
    Tata Memorial Centre and homi BhaBha National Institute, Mumbai.
    Mumbai, Maharashtra, India

    Disclosure information not submitted.

  • Eric Joseph Dozois, Professor of Surgery

    Chair, Colon and Rectal Surgery
    Mayo Clinic
    Rochester, Minnesota, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no relevant relationships with ineligible companies.

  • AE

    Amanda Ersryd, MD

    Consultant Colorectal Surgeon
    Oslo University Hospital
    Oslo, Oslo, Norway

    Disclosure information not submitted.

  • FF

    Frank A. Frizelle, MBCHB, MMedSCi, FRACS

    Professor of surgery
    University of Otago
    Christchurch, Canterbury, New Zealand

    Disclosure information not submitted.

  • JF

    Jonas A. Funder, n/a

    Consultant, associationernes. professor
    University Hospital of Southern Denmark
    Hinnerup, Midtjylland, Denmark

    Disclosure information not submitted.

  • Julio Garcia Aguilar

    Disclosure information not submitted.

  • TG

    Tamara Glyn, FRACS, PhD

    Senior Lecturer
    University Of Otago, Christchurch
    Christchurch, Canterbury, New Zealand

    Disclosure information not submitted.

  • HA

    Heriot G. Alexander, MD, MBA, FRACS, FRCS

    Colorectal Surgeon
    Division of Cancer Surgery, Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia
    Melbourne, Victoria, Australia

    Disclosure information not submitted.

  • YK

    Yukihide Kanemitsu, MD

    Chief, Department of Colorectal Surgery
    National Cancer Center, Japan
    Tokyo, Tokyo, Japan

    Disclosure information not submitted.

  • CK

    Chia Yew Kong, MB ChB MSc MRCS

    Honorary Clinical Lecturer in Surgery
    Academic Unit of Surgery, Glasgow Royal Infirmary
    University of Glasgow
    Glasgow, Scotland, United Kingdom

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • HK

    Helle Ø Kristensen, MD, PhD

    Attending Surgeon, Department of Surgery
    Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
    Aarhus N, Midtjylland, Denmark

    Disclosure information not submitted.

  • SM

    Songphol Malakorn, MD

    Assistant Professor
    Chulalongkorn Colorectal Research Unit, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
    Bangkok, Krung Thep, Thailand

    Disclosure information not submitted.

  • DM

    David M. Mens, MD

    PhD Candidate
    Erasmus MC Cancer Center
    Rotterdam, Zuid-Holland, Netherlands

    Disclosure information not submitted.

  • PN

    Per J. Nilsson, n/a

    Consultant Surgeon/Senior Lecturer
    Karolinska Universitetssjukhuset
    Stockholm, Stockholms Lan, Sweden

    Disclosure information not submitted.

  • GP

    Gabriella Palmer, Prof Anna Martling

    assocate professor and senior lecturer at the section of colorectal surgery
    Karolinska Universitetssjukhuset
    Stockholm, Stockholms Lan, Sweden

    Disclosure information not submitted.

  • Emmanouil Pappou, MD, PhD

    Assistant Attending
    Memorial Sloan Kettering Cancer Center
    New York, New York, United States

    Disclosure information not submitted.

  • MQ

    Martha Quinn, Frcs

    Consultant Surgeon
    Glasgow royal infirmary
    DUNBLANE, Scotland, United Kingdom

    Disclosure information not submitted.

  • AQ

    Aaron Quyn, MBChB FRCS PhD

    Associate Professor
    University of Leeds
    Leeds, England, United Kingdom

    Disclosure information not submitted.

  • CS

    Chucheep Sahakitrungruang, MD

    Professor of Surgery
    Division of Colorectal Surgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
    Bangkok, Krung Thep, Thailand

    Disclosure information not submitted.

  • Avanish P. Saklani, FRCS

    Professir Robotic / colorectal
    Tata Memorial Hospital ,
    Tata Memorial hospital , Mumbai
    Mumbai, Maharashtra, India

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • AS

    Arne M. Solbakken, MD, PhD

    Consultant
    The Radium Hospital, Oslo University Hospital
    Oslo, Oslo, Norway

    Disclosure information not submitted.

  • JT

    Jim Tiernan, MD PhD FRCS

    Consultant Colorectal Surgeon
    John Goligher Colorectal Unit
    Leeds, England, United Kingdom

    Disclosure information not submitted.

  • CV

    Cornelis Verhoef, MD PhD

    Head of the Department of Surgical Oncology and GastroIntestinal Surgery
    ErasmusMC Cancer Institute
    Rotterdam, Zuid-Holland, Netherlands

    Disclosure information not submitted.

    • Senior Author(s)

  • DS

    Daniel Steffens, BPhty (Hons I), PhD

    Director
    Surgical Outcomes Research Centre (SOuRCe)
    Syndey, New South Wales, Australia

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Celine Garrett, MBBS (Hons), MPhil: This individual has no financial relationships with ineligible companies.
Eric Joseph Dozois, Professor of Surgery: This individual has no relevant relationships with ineligible companies.
Richard Garfinkle, MD, MSc, PhD: This individual has no relevant relationships with ineligible companies.
Chia Yew Kong, MB ChB MSc MRCS: This individual has no financial relationships with ineligible companies.
Avanish P. Saklani, FRCS: This individual has no financial relationships with ineligible companies.
Purpose/Background: Pelvic exenteration (PE) is the treatment of choice for selected patients with locally advanced primary rectal cancer (LARC) and locally recurrent rectal cancer (LRRC). Historically, involvement of major pelvic neurovascular structures and bone was considered a contraindication to PE. However, exenterative techniques have evolved, and en bloc major bone and neurovascular resection techniques can now be performed safely. These have been designated 'high-complexity' procedures in the recent Pelvic Exenteration Lexicon. This study aimed to compare short-term outcomes of 'conventional' versus 'high-complexity' total pelvic exenteration (TPE).

Methods/Interventions: International multicentre retrospective cohort study across 16 specialised exenteration centres from 12 countries. Patients underwent TPE for LARC or LRRC between January 2018-January 2023. Conventional TPE was defined as en bloc resection of rectum, anus, genitourinary viscera, regional lymph nodes, and peritoneum. High-complexity TPE included additional en bloc resection of bony (sacrum, pubic or ischium), neurological (sciatic or femoral nerves, lumbosacral trunk, high sacral nerve roots) and/or vascular (common iliac, external iliac or aorta) pelvic structures. Data were extracted from prospectively maintained databases. Primary outcomes included perioperative resource utilisation, morbidity, mortality and oncological (R0) outcomes.

Results/Outcomes: 763 patients underwent TPE: 478 (63%) conventional and 285 (37%) high-complexity procedures. High-complexity TPE was more commonly required in LRRC than LARC patients (53% vs 27%, p< 0.001). Among high-complexity procedures, en bloc sacrectomy was most common (n=249, 87%), followed by major nerve resection (n=56, 20%), ischial bone resection (n=48, 17%), major vascular resection (n=23, 8%), and pubic bone resection (n=19, 7%). For LARC and LRRC patients, high-complexity TPE was associated with longer operative time (600 vs 480 mins, p< 0.001 and 623 vs 480 mins, p< 0.001), respectively), ICU stay (2 vs 1 day, p< 0.001 and 3 vs 1 day, p< 0.001, respectively), hospital stay (19 vs 15 days, p=0.008 and 23 vs 15 days, p< 0.001, respectively), and higher blood loss (2000 vs 1236 mL, p< 0.001 and 3000 vs 1600 mL, p< 0.001, respectively). Importantly, between high-complexity and conventional groups, R0 resection (LARC: 87% vs 82%, p=0.196; LRRC: 75% vs 76%, p=0.877), morbidity (LARC: 33 vs 30, p=0.384; LRRC: 41 vs 42, p=0.902) and mortality (LARC: 1 vs 2, p=0.816; LRRC: 3 vs 5, p=0.378) rates were comparable.

Conclusion/Discussion: High-complexity TPE for LARC and LRRC can be performed safely at high-volume specialised centres with morbidity, mortality, and R0 resection rates comparable to conventional procedures. These techniques are resource-intensive but should be considered standard care for appropriately selected patients with tumours involving major pelvic bone or neurovascular structures, supporting centralisation to expert centres with institutional experience and appropriate resourcing.