Beyond TME: When and How Should We Extend the Boundaries of Pelvic Cancer Surgery? Pelvic Exenteration, Extra-Anatomical Resection and Lateral Pelvic Lymph Nodes

The management of locally advanced and recurrent rectal cancer increasingly challenges the traditional anatomical boundaries of total mesorectal excision. Achieving meaningful oncological benefit requires careful patient selection, high-quality imaging, multidisciplinary decision-making and, in selected patients, a willingness to extend surgery beyond conventional planes. This seminar will explore contemporary indications and techniques for extended pelvic surgery, including pelvic exenteration and extra-anatomical resection for advanced and recurrent disease, with particular emphasis on achieving an R0 resection while balancing morbidity, function and quality of life. The evolving management of lateral pelvic lymph nodes will also be addressed, including when and how these should be treated in the era of neoadjuvant therapy and advanced imaging.

Drawing on extensive experience in complex pelvic cancer surgery, the presentation will examine how modern multidisciplinary care, surgical innovation and appropriate extension of anatomical boundaries can offer potentially curative treatment to patients historically considered to have unresectable disease.