Multivisceral Pelvic Surgery for Advanced Malignancies: Oncological Clearance, Urinary Reconstruction, and Long-Term Functional Outcomes
DOI:
https://doi.org/10.64784/344Palabras clave:
multivisceral pelvic surgery, pelvic exenteration, locally advanced pelvic cancer, R0 resection, urinary preservation, urinary reconstruction, urinary diversion, postoperative morbidity, oncological outcomes, quality of lifeResumen
Multivisceral pelvic surgery represents a complex therapeutic strategy for patients with locally advanced or recurrent pelvic malignancies in whom conventional organ-specific resection may be insufficient to achieve adequate oncological clearance. This study aimed to analyze the relationship between surgical radicality, urinary tract preservation or reconstruction, postoperative morbidity, oncological control, and quality of life. An integrative review guided by the Scientific Method was conducted using evidence from PubMed/MEDLINE, Scopus, Web of Science, and Embase, focusing on contemporary studies published between 2015 and 2026. The analysis incorporated oncological, urological, surgical, and patient-centered outcomes. Contemporary PelvEx data demonstrated an increase in R0 resection rates from 79.8% to 84.8% in locally advanced rectal cancer and from 55.4% to 71.7% in locally recurrent disease, despite a greater frequency of extended resections. Major complication rates decreased from 37.8% to 23.1% in locally advanced disease and from 32.1% to 23.9% in recurrent disease. Urinary reconstruction remained heterogeneous, and comparative evidence showed similar rates of grade III–IV complications between continent and non-continent diversion, at 42.9% and 42.3%, respectively, with urinary complication rates of 15.9% and 16.7%. Longitudinal quality-of-life data showed early postoperative deterioration in some functional domains followed by progressive recovery, with overall quality-of-life scores returning toward or exceeding baseline during follow-up in many patients. These findings indicate that contemporary multivisceral pelvic surgery can achieve high rates of complete oncological resection while maintaining acceptable functional outcomes when performed in appropriately selected patients within specialized multidisciplinary centers. Surgical success should therefore be defined through the integrated assessment of R0 resection, urinary preservation or individualized reconstruction, perioperative safety, and long-term quality of life.
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