RE Surveillance After Pelvic Exenteration: A Systematic Review of Oncological and Functional Follow‐Up

We read with interest the systematic review by Siu et al. [1] addressing surveillance strategies following pelvic exenteration. Given the magnitude of this procedure and the significant morbidity associated with recurrence, their synthesis of the available evidence is both timely and clinically relevant. The review highlights the absence of standardised postoperative surveillance protocols and the heterogeneity in imaging schedules, tumour markers and clinical follow-up intervals. This variability reflects the rarity and complexity of pelvic exenteration, where primary tumour biology, margin status and nodal involvement differ substantially across colorectal, gynaecological and urological malignancies. While the authors appropriately emphasise the limited high-quality evidence supporting intensive surveillance, the discussion may benefit from further consideration of risk stratification. A uniform surveillance schedule may not be appropriate in this cohort. Patients with R1 resections, positive nodes or aggressive histopathology may derive greater benefit from closer imaging intervals, whereas low-risk patients may be safely managed with less intensive follow-up, thereby reducing healthcare burden and patient anxiety. Additionally, the role of cross-sectional imaging should be balanced against cost-effectiveness and cumulative radiation exposure, particularly in younger patients. Prospective multicentre registries may help clarify whether earlier detection of recurrence translates into improved survival or merely reflects lead-time bias [2]. Despite the intuitive appeal of intensive surveillance, improved post-recurrence survival does not necessarily equate to reduced disease-specific mortality. Despite the limitations inherent in the available data, this review underscores a critical gap in oncological surgery: the need for consensus-driven, risk-adapted surveillance pathways after pelvic exenteration. Collaborative efforts will be essential to develop evidence-based guidelines that optimise oncological outcomes while minimising unnecessary intervention. Zied Hadrich: writing – original draft, writing – review and editing, validation. Mohamed Hajri: writing – review and editing, writing – original draft. The authors have nothing to report. The authors declare no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.