Abstract
Composite resection, when malignancy extends into the sacrum, means that any pelvic exenteration to be undertaken will require the addition of bone resection in order to obtain clear margins. The aim of an extended resection involving bone is to achieve an oncological resection, while maintaining acceptable function and minimizing operative morbidity. Bony resection is indicated in cases where soft tissue resection alone would pose a risk to positive surgical margins. Patients with advanced primary or recurrent rectal cancer comprise the majority of patients undergoing bony resection. Patients being considered for pelvic exenteration should undergo a high‐risk anesthetic pre‐assessment clinic. Cardiopulmonary exercise testing can be useful when there is concern as it provides an objective assessment of fitness for surgery. Neoadjuvant radiotherapy can improve the rate of R0 resection.