Robotic total pelvic excenteration – audit from a tertiary referral center for locally advanced pelvic cancer

Introduction The aim was to perform a retrospective review of short term outcomes of robotic total pelvic excenterations (rTPE) at a tertiary referral center. Results were compared to open total pelvic excenterations (oTPE) during the same time period. Method Data were retrieved from electronic medical records. All patients operated with rTPE or oTPE from 2014 until 2024 were included. TPE was defined as complete cystectomy combined with total or partial rectal resection. Result In total, 210 patients were operated with total pelvic excenteration and of those 23 patients underwent rTPE, the majority for pelvic malignancy and a minority due to chronic pelvic fistula. 84% were males. 32% of the patients were referred from another region. Patients in the rTPE group were older than in the oTPE group (median age 72 vs 68, P < 0.001) and had higher ASA score (III-IV 74% vs 47% P < 0.047). Operation time was similar (566 min vs 540 min, P = 0.88) but intraoperative bleeding was lower (550 ml vs 2085 ml, P < 0.001). The proportion of patients with postoperative serious adverse events was smaller in the rTPE-group (Clavien-Dindo > II: 17% vs 34%, P < 0.085). Lengt of stay was similar (11 vs 12 days). In the rTPE group R0 resection was achieved in all patients with colorectal malignancy (100%). One rTPE was converted to oTPE (4%). The proportion of rTPE increased over time (3% 2014-2020 vs 20% 2021-2024, P < 0.001). Discussion rTPE is associated with favorable short term outcomes in selected cases and has been increasingly performed over time.