Systematic Review and Meta-analysis of Perioperative Outcomes of Minimally Invasive and Open Pelvic Exenteration for Locally Advanced and Recurrent Colorectal Cancer
In brief
Minimally invasive pelvic exenteration cuts overall complications by 30%
In a meta-analysis of 14 observational studies (1,428 patients), minimally invasive pelvic exenteration reduced total postoperative complications by about one-third and wound infections by 60% compared with open surgery, while blood loss and hospital stay were also markedly lower. Major complications, mortality and R0 resection rates were similar, but the evidence is observational and subject to selection bias.
- Journal
- Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract (Q1)
- Published
- 22 September 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Sameh Hany Emile, Michelle Hambleton, Melissa Ulbrick, Ahmed Hossam Elsayed
- PMID
- 42772509
- DOI
- 10.1016/j.gassur.2026.102613
Why clinicians should know about it
- Picked for Surgical Oncology (paper of the day, 24 September 2026): MI pelvic exenteration outcomes, surgical decision
- Picked for Surgery (paper of the day, 24 September 2026): MIS vs open pelvic exenteration for colorectal cancer
Abstract
BACKGROUND: Pelvic exenteration (PE) is a complex surgery used for locally advanced and recurrent colorectal cancer. With most PE procedures performed via laparotomy, the role of minimally invasive surgery (MIS) in PE remains unclear. This systematic review aimed to assess perioperative outcomes of MI compared to open PE in locally advanced and recurrent colorectal cancer. METHODS: A PRISMA-compliant systematic search of PubMed, Scopus, and Google Scholar was conducted through March 2026. Studies comparing MI (laparoscopic or robotic) with open PE for locally advanced colorectal cancer were included. The primary outcome was postoperative complications, and secondary outcomes were blood loss, operating time, hospital stay, 30-day mortality, readmission, and R0 resection. Random-effects meta-analyses were performed using risk ratios (RR) and weighted mean differences (WMD). RESULTS: A total of 14 observational studies, including 1,428 patients (610 MI, 818 open), were included. MI PE was associated with a significantly lower risk of total complications (RR 0.70, 95% CI 0.55-0.89, p=0.003) and wound infections (RR 0.40, 95% CI 0.23-0.69, p=0.0009). Major complications were comparable overall but lower with laparoscopic-only PE. MIS was associated with significantly lower blood loss (WMD -632mL, p<0.001) and shorter hospital stay (WMD -4.43 days, p=0.0006), with similar operating time. There were no differences in 30-day mortality or readmission. The R0 resection rates were similar (RR 1.03, p=0.191). CONCLUSIONS: MI PE is likely associated with favorable perioperative outcomes compared to open PE. Therefore, MIS may be used in select patients undergoing PE. However, our findings should be cautiously interpreted because the current evidence is mainly observational and remains prone to selection bias and residual confounding.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.