INTRODUCTION: Pelvic exenteration is traditionally reserved for patients with recurrent gynecologic cancer that is refractory to chemotherapy or radiotherapy, with the primary goal of curative intent. Exenteration also remains an option for palliative symptom relief in a select group of patients. While traditional pelvic exenteration performed via laparotomy is associated with significant morbidity, minimally invasive approaches have emerged as alternatives with potential for reduced perioperative complications. Despite its potential benefits, data on robotic-assisted laparoscopic pelvic exenteration, particularly for palliative intent, remains limited. This study evaluates surgical and oncologic outcomes of robotic-assisted pelvic exenteration performed for palliation in a contemporary cohort. OBJECTIVE: To assess the morbidity, operative, and oncological outcomes of robotic-assisted pelvic exenteration performed with mixed/palliative intent for patients with advanced or recurrent gynecologic malignancies. METHODS: This retrospective case series reviewed electronic medical records of patients undergoing robotic-assisted pelvic exenteration for palliative intent between 2015 and 2025 at a single tertiary academic center. Palliative intent was defined as surgery performed to relieve symptoms such as pain, bleeding, fistula, hygiene, or obstruction without curative aims. Cases with unexpectedly favorable pathology (negative margins or low tumor burden) were categorized as “mixed intent.” Data collected included demographics, prior treatments, surgical details, postoperative complications, readmissions, and follow-up outcomes. Margins were classified according to UICC criteria and measured to distinguish close (<3 mm) from distant (≥3 mm) clearance. RESULTS: Eleven patients (median age 70 years) underwent robotic-assisted pelvic exenteration for gynecologic cancers. Most had extensive treatment histories, including radiotherapy (100%) and chemotherapy (91%). Total, anterior, and posterior exenterations were performed in 36.3%, 45.5%, and 18.2% of patients, respectively, with no intraoperative conversions. Surgical complexity was high, with individualized resections involving multiple pelvic compartments. Median estimated blood loss was 350 mL. There was one intraoperative complication (rectal injury), and no 30-day mortality. However, postoperative complications occurred in 63.6% of patients, and 27.3% required reoperation. Readmission within 30 days occurred in 54.5% of cases. Urinary diversion was performed in 81.8%, and bowel diversion in 54.5% of patients. Median follow-up was 6.5 months (range: 0.5–92.2), and 6-month overall survival was estimated at 83.3%, and no further deaths occurred. Local recurrence rate was 45 percent. CONCLUSIONS: Robotic-assisted pelvic exenteration for mixed/palliative intent is feasible and associated with acceptable intraoperative outcomes, including low blood loss and zero perioperative mortality. Our findings are consistent with other reports in the literature. Although postoperative morbidity is less than laparotomic approach, readmission rates remain still high, highlighting the need for careful patient selection and multidisciplinary planning. This study contributes novel data to a sparsely studied area and suggests that the robotic approach may offer a viable option for symptom control in select patients with advanced gynecologic malignancy.
Varea et al. (Fri,) studied this question.