Surveillance After Pelvic Exenteration: A Systematic Review of Oncological and Functional Follow‐Up

BACKGROUND: Surveillance following cancer surgery with curative intent serves the purpose of permitting early detection of recurrent disease in addition to monitoring and management of post-resection functional sequelae. Although recommendations exist for most primary cancers, in the context of radical or re-operative surgery such as pelvic exenteration (PE), whether these strategies are appropriate is unclear. The purpose of this review was to evaluate the oncological and functional follow-up strategies after PE. METHODS: A comprehensive literature search was conducted across PubMed, Embase, Medline, and Cochrane databases for studies published between January 2000 and December 2024. Eligible studies reported long-term oncological and/or functional follow-up after PE. Studies including other surgical procedures, short-term (< 12 month) follow-up, non-English articles, and case reports were excluded. Data extracted included follow-up length, frequency, and investigation type. Risk of bias was assessed using the AGREE-II and ROBINS-I tools. RESULTS: Forty-two studies were included, comprising 39 cohort studies and three non-original articles. Oncological follow-up, described in 28 studies, frequently included clinic visits every 3-4 months for the first 2-3 years, transitioning to annual reviews after 5 years. Modalities such as tumour markers, CT and MRI imaging, and colonoscopies varied widely. Functional follow-up was addressed in 19 studies, utilising validated instruments including the EORTC QLQ-C30 and SF-36. Most studies lacked standardisation, and no single article comprehensively addressed both oncological and functional aspects. CONCLUSION: Current follow-up practices after PE exhibit significant heterogeneity, highlighting the need for standardised protocols. Future research should focus on appropriately sized prospective cohort studies and randomised trials to develop evidence-based guidelines tailored to the unique needs of this high-risk patient population.