Creating pelvic exenteration services: obstacles, cultural factors, and learning experiences from the first specialized service in Saudi Arabia and the Gulf region

Pelvic Exenteration has evolved over the years into a multidisciplinary collaboration that requires structural elements and staffed roles beyond surgeons alone. Establishing such a service requires integrated multidisciplinary pathways, specialized imaging and anesthesia support, experienced perioperative nursing, stoma and wound care expertise, and administrative support, along with a culture that embraces centralization and high-risk oncologic surgery. Centers without previously existing exenteration programs face additional challenges, including institutional, cultural, financial, technical, and clinical. This article provides an in-depth review of the required elements for establishing such an advanced service, including the associated potential barriers, and shares our experience in establishing the first pelvic exenteration service in Saudi Arabia and the Gulf region.