Abstract
Background: Pelvic exenteration (PE) has evolved from a palliative "procedure of desperation" into a potentially curative operation for selected patients with locally advanced or recurrent pelvic malignancy. Christchurch Hospital has delivered PE for more than three decades and has been an active contributor to the international development of these procedures.
Methods: Retrospective description of the Christchurch PE programme and its evolution since the mid‑1990s, contextualised against contemporary multicentre evidence, is provided. Service components evaluated include multidisciplinary governance, patient selection, operative strategies for posterior and lateral compartment disease (including sacrectomy), peri‑operative optimisation and survivorship pathways.
Results: Since 1995, Christchurch has undertaken over 520 multivisceral pelvic resections. Centralisation of complex patient care supports operative volume, consistency of team performance and benchmarking against international standards. Prospective audits with collaborative international research have strengthened the understanding of what drives good oncological outcomes (particularly the impact of R0 resection), as well as morbidity patterns in high‑risk sub-groups, feasibility of repeat PE and patient‑reported outcomes including quality of life.
Conclusion: A centralised multidisciplinary programme can safely deliver ultra‑complex pelvic oncology surgery. Continued international collaboration and systematic capture of patient‑reported outcomes will define the next phase of PE service development.