Perineal reconstruction for advanced pelvic malignancies

Curative treatment of locally advanced and recurrent malignant pelvic tumours requires radical surgical excision. The goal of potentially curative surgery is complete resection with pathologically clear (R0) margins1. The proximity of organs within the pelvis means that surgery for advanced tumours frequently requires a tailored multidisciplinary approach. Radical surgery often results in large and complex defects that necessitate specialist reconstruction. Radicality of oncological resection will depend on the pathology and extent of malignancy. When disease involves one or more pelvic organs some form of pelvic exenteration (PE) is usually required. Pelvic exenteration can be classified anatomically as anterior, posterior, or total, depending on the organs excised (Fig. 1). A recent attempt to standardise nomenclature defined PE procedures as Conventional (‘a major surgical procedure where all or most organs in the pelvic cavity are removed’) or Highly Complex (‘conventional PE with the extension of surgery to remove bony structures or structures in the pelvic sidewall’)2.