Pelvic exenteration morbidity and mortality lower in contemporary gynecologic cancer series

A systematic review and meta-analysis published in Annals of Surgical Oncology compared pelvic exenteration outcomes for locally advanced or recurrent gynecologic cancers between Brunschwig-era series (1954–1969) and contemporary series (1990–2024). The PROSPERO-registered review included 34 retrospective studies comprising 5,478 patients: 913 historical and 4,565 contemporary. Outcomes included major postoperative morbidity, perioperative mortality, and oncologic outcomes; major morbidity was harmonized to Clavien–Dindo grade III or higher, or equivalent.

Pooled major morbidity was 58% (95% CI 46–68%) in historical series versus 23% (95% CI 17–31%) in contemporary series. Perioperative mortality was 23% (95% CI 17–30%) versus 3% (95% CI 2–4%), respectively. Contemporary reports also described improved oncologic outcomes, but heterogeneity and differences in follow-up prevented direct survival comparisons.

These findings provide context for counseling patients about contemporary surgical risks, although major complications remain substantial. All included studies were retrospective, and differences in patient selection, treatment intent, and clinical practice constrain interpretation. The historical search deliberately focused on Brunschwig and his team rather than all series from that era. The results therefore do not establish which changes in care account for the observed differences or quantify a survival benefit.