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Cancers
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Radical Pelvic Surgery and Reconstructive Innovations in Pelvic Oncology
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Radical Pelvic Surgery and Reconstructive Innovations in Pelvic Oncology

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Clinical Research of Cancer".

Deadline for manuscript submissions: 30 April 2026 | Viewed by 2811

Special Issue Editor

Dr. Evrim Erdemogľu

E-Mail Website
Guest Editor
Department of Medical and Surgical Gynecology, Mayo Clinic, Phoenix, AZ, USA
Interests: cancer

Special Issue Information

Dear Colleagues,

Radical pelvic surgery is fundamental in the treatment of advanced or recurrent gynecologic and pelvic cancers. Procedures such as pelvic exenteration, LEER (laterally extended endopelvic resection), and multivisceral resections require surgical expertise and multidisciplinary planning. Despite their complexity, these surgeries show therapeutic potential in specific patients, but certain aspects are still not adequately documented in the literature, including technical methodologies, selection criteria, perioperative results, and reconstructive techniques. This Special Issue will explore novel surgical techniques, anatomical obstacles, intraoperative decision-making, and reconstructive strategies in relation to radical pelvic surgery. We welcome submissions of original research, surgical atlases, video articles, or expert reviews pertaining to pelvic exenteration, LEER, vascular or nerve dissection, bowel or urine diversion, or flap-based repair. We invite publications that examine results, surgical planning, and quality of life post-radical resection.

For this Special Issue, original research articles and reviews are welcome. Research areas may include (but are not limited to) the following:

- Pelvic exenteration and LEER techniques;

- Multivisceral and compartmental resections;

- Surgical anatomy and intraoperative navigation;

- Perioperative outcomes and complication management;

- Reconstructive surgery (flaps, conduits, neovaginas, etc.);

- Robotic and minimally invasive approaches in radical pelvic surgery;

- Quality of life and survivorship.

We also welcome articles exploring outcomes, surgical planning, and quality of life following radical resection.

We look forward to receiving your contributions.

Dr. Evrim Erdemogľu
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pelvic exenteration
  • LEER
  • radical pelvic surgery
  • reconstruction
  • flap surgery
  • multivisceral resection
  • gynecologic oncology
  • pelvic cancer
  • surgical outcomes
  • minimally invasive surgery

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Published Papers (4 papers)

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Research

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17 pages, 1362 KB  
Article
Unlocking Tumor Aggressiveness in Endometrial Cancer: AI-Driven PET/CT Radiomics and Machine Learning for Prediction of High-Risk Tumor Histology
by Samet Yagci, Evrim Erdemoglu, Mehmet Erdogan, Mustafa Avci, Ahmet Tunc, Ismail Ozkoc and Sevim Sureyya Sengul
Cancers 2026, 18(6), 905; https://doi.org/10.3390/cancers18060905 - 11 Mar 2026
Viewed by 421
Abstract
Purpose: Accurate preoperative risk stratification in endometrial cancer (EC) is essential for guiding surgical and therapeutic decisions. This study aimed to evaluate the discriminative performance of [18F]-FDG PET/CT-derived radiomic features combined with machine learning models for differentiating low-risk (LRH-EC) and high-risk histology (HRH-EC) [...] Read more.
Purpose: Accurate preoperative risk stratification in endometrial cancer (EC) is essential for guiding surgical and therapeutic decisions. This study aimed to evaluate the discriminative performance of [18F]-FDG PET/CT-derived radiomic features combined with machine learning models for differentiating low-risk (LRH-EC) and high-risk histology (HRH-EC) subtypes. Methods: A total of 159 patients with histopathologically confirmed EC who underwent preoperative [18F]-FDG PET/CT were retrospectively analyzed. Radiomic features were extracted using LIFEx version 7.4.0 software following IBSI guidelines. After FDR correction and Pearson correlation–based redundancy reduction (|r| > 0.80), 16 radiomic features were retained for modeling. Three feature configurations (Conventional PET parameters, Radiomics16, and Combined) were evaluated. Machine learning models were developed using stratified 5-fold cross-validation. Model performance was assessed using AUC, accuracy, sensitivity, specificity, F1-score, Wilson confidence intervals, DeLong’s test, and McNemar’s test. Results: Artificial Neural Network (ANN) (AUC = 0.709) and Random Forest (RF) (AUC = 0.686) achieved the highest discriminative performance within the Radiomics16 feature set. No statistically significant superiority between algorithms or feature configurations was observed by DeLong analysis. However, McNemar’s test demonstrated significant patient-level classification differences for the Combined ANN model (p < 0.001). NGTDM_Coarseness and SUVmin emerged as the most influential features, reflecting tumor heterogeneity and metabolic activity. Conclusions: [18F]-FDG PET/CT-based radiomics combined with machine learning provides moderate yet consistent discrimination between LRH-EC and HRH-EC. While external validation is required, this approach may support noninvasive preoperative risk stratification in endometrial cancer. Full article
(This article belongs to the Special Issue Radical Pelvic Surgery and Reconstructive Innovations in Pelvic Oncology)
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Review

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15 pages, 556 KB  
Review
Robotic Rectus Muscle Flap Reconstruction After Pelvic Exenteration in Gynecological Oncology: Current and Future Perspectives—A Narrative Review
by Gurhan Guney, Ritchie M. Delara, Johnny Yi, Evrim Erdemoglu and Kristina A. Butler
Cancers 2026, 18(3), 375; https://doi.org/10.3390/cancers18030375 - 25 Jan 2026
Viewed by 488
Abstract
Background/Objectives: Pelvic exenteration is a radical procedure performed for recurrent gynecologic cancers. The goal of exenteration is to prolong survival, but this procedure also results in extensive tissue loss and consequently high morbidity. Reconstruction using vascularized flaps, particularly the VRAM flap, is [...] Read more.
Background/Objectives: Pelvic exenteration is a radical procedure performed for recurrent gynecologic cancers. The goal of exenteration is to prolong survival, but this procedure also results in extensive tissue loss and consequently high morbidity. Reconstruction using vascularized flaps, particularly the VRAM flap, is crucial to restoring pelvic integrity and decreasing complications resulting from extensive tissue loss. With the rise of minimally invasive surgery, the traditionally open abdominal approach to exenteration and reconstruction can now be performed with the assistance of robotic platforms. This review aims to summarize available evidence, describe techniques, and propose future directions for robotic rectus flap reconstruction after pelvic exenteration. Methods: This narrative review was conducted following the SANRA guidelines for narrative synthesis. A comprehensive search of PubMed, Embase, Scopus, and Web of Science was conducted for studies published between January 2000 and November 2025 on pelvic exenteration followed by robotic rectus abdominis flap reconstruction in gynecologic oncology. Eligible studies were retrospective or prospective reports, technical descriptions, case series, or comparative analyses. Non-robotic techniques and animal studies were excluded. Although the primary focus was gynecologic oncology, technically relevant studies from other oncologic disciplines were included when the reconstructive approach was directly applicable to pelvic exenteration. Extracted data included patient demographics, surgical details, and perioperative and oncologic outcomes. Results: The literature search identified primarily case reports and small single-center series describing robot-assisted rectus muscle-based flap reconstruction after pelvic exenteration. Reported cases demonstrated technical feasibility and successful flap harvest using robotic platforms, with adequate pelvic defect coverage. Potential benefits, such as reduced wound morbidity and preservation of a minimally invasive workflow, have been described. However, patient numbers were small, techniques varied, and standardized outcome measures or comparative data with open approaches were lacking. Conclusions: Robotic rectus flap reconstruction represents a promising advancement in pelvic exenteration surgery, potentially reducing morbidity and improving recovery. Further research, including multicenter prospective studies, is needed to validate these findings and establish standardized protocols. Full article
(This article belongs to the Special Issue Radical Pelvic Surgery and Reconstructive Innovations in Pelvic Oncology)
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Other

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24 pages, 1083 KB  
Systematic Review
Fertility Preservation Strategies in Women with Pelvic Gynecologic Malignancies Undergoing Multimodal Oncologic Treatment: A Systematic Review
by Yasemin Dadas, Gokalp Oner, Enes Karaman, Durmus Ayan, Hande Nur Doganay, Ergul Bayram, Nazli Tunca Sanlier and Busra Kulular
Cancers 2026, 18(7), 1142; https://doi.org/10.3390/cancers18071142 - 2 Apr 2026
Viewed by 333
Abstract
Background/Objectives: Oncologic surgery to the pelvis and post-surgery adjuvant therapy are dangerous to the reproductive potential of childbearing-aged women. Clinical practices in fertility preservation (FP) have become an essential aspect of multidisciplinary cancer care; however, uniform practices remain inconsistent among the different [...] Read more.
Background/Objectives: Oncologic surgery to the pelvis and post-surgery adjuvant therapy are dangerous to the reproductive potential of childbearing-aged women. Clinical practices in fertility preservation (FP) have become an essential aspect of multidisciplinary cancer care; however, uniform practices remain inconsistent among the different varieties of cancer and/or areas. To systematically compare the fertility preservation procedures employed in women who have undergone pelvic oncologic surgery and to measure their reproductive and oncologic stages. This review focuses primarily on gynecologic pelvic malignancies and addresses fertility preservation strategies within the context of multimodal oncologic care, including surgery, chemotherapy, radiotherapy, and multidisciplinary decision-making. Methods: A systematic review was performed using PRISMA 2020 to investigate publications from to 2013–2025 in PubMed, Embase, Scopus, Cochrane Library, and Web of Science. The inclusion criteria were women of childbearing age with pelvic malignancies who underwent either fertility-sparing or cryopreservation procedures. PICO-based data mining was performed, and AMSTAR 2, NOS, and AGREE II methodological quality evaluation instruments were used. Mixed inductive–deductive thematic analysis was used to synthesize the findings of the study. Results: A range of articles, including systematic reviews, cohort studies, and clinical guidelines, were included. Fertility-sparing surgery and cryopreservation were found to be as safe and oncologically effective as traditional therapy, with a five-year survival rate of more than 90. Cryopreservation maintained the functioning of the ovary in over 60 percent of the patients and recorded live delivery rates of up to 40 percent. Thematic analysis revealed five main spheres: oncologic safety, creation of FP approaches, psychosocial benefits, limiting access, and the necessity of standardized procedures. Conclusions: Fertility preservation can securely supplement oncologic treatment courses, favoring tumor traits and individual preferences. Unified reporting, extended follow-up, and equitable access are pertinent in maximizing results and reproductive self-corrective action among female cancer endocrine survivors. Fertility preservation should be considered as an integral component of multidisciplinary oncologic management in women with gynecologic pelvic cancers, extending beyond surgical approaches to include coordinated medical, reproductive, and supportive care. Full article
(This article belongs to the Special Issue Radical Pelvic Surgery and Reconstructive Innovations in Pelvic Oncology)
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13 pages, 1182 KB  
Systematic Review
Double-Barrel Uro-Colostomy Versus Ileal Conduit for Urinary Diversion After Pelvic Exenteration: A Systematic Review and Meta-Analysis of Comparative Outcomes
by Ahmed Salama, Gavin Calpin, Mahmoud Salama, Ben Creavin, Patrick J. Maguire, Peter Lonergan, Jonathan Cho, Feras Abu Saadeh, Louise McLoughlin, Tarik Sammour and Michael E. Kelly
Cancers 2025, 17(21), 3479; https://doi.org/10.3390/cancers17213479 - 29 Oct 2025
Viewed by 1100
Abstract
Introduction: Pelvic exenteration is a radical operation for advanced or recurrent pelvic malignancies, requiring urinary and faecal diversion. The ileal conduit (IC) remains the standard urinary diversion, while the double-barrel uro-colostomy (DBUC) has re-emerged as an alternative that avoids small bowel anastomosis and [...] Read more.
Introduction: Pelvic exenteration is a radical operation for advanced or recurrent pelvic malignancies, requiring urinary and faecal diversion. The ileal conduit (IC) remains the standard urinary diversion, while the double-barrel uro-colostomy (DBUC) has re-emerged as an alternative that avoids small bowel anastomosis and consolidates diversion into a single stoma. Aims: To evaluate comparative outcomes of DBUC versus IC to clarify relative risks and potential benefits. Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines and registered on PROSPERO (CRD420251090885). PubMed, Scopus, EMBASE, and Medline were searched to March 2025 for studies directly comparing DBUC and IC following pelvic exenteration. Eligible studies reported perioperative or urological outcomes. Results: Four retrospective studies (164 patients; DBUC 88, IC 73) were included. Urinary leak was lower with DBUC (10.2% vs. 15.1%), with pooled analysis showing a higher risk in IC (RR 2.52, 95% CI 1.02–6.20, p = 0.04). Pyelonephritis (42.0% vs. 15.3%; RR 1.37, p = 0.24) and electrolyte derangements (20.6% vs. 15.6%; RR 1.21, p = 0.64) did not differ significantly. Rates of urinary and enteric fistulas were similar. Clavien–Dindo grade III (42.1% vs. 37.1%) and grade IV complications (17.1% vs. 24.2%) were also comparable between groups. Conclusion: DBUC is a feasible alternative to IC after pelvic exenteration, with reduced urinary leak rates and comparable morbidity. Its single-stoma approach may offer patient-centred advantages. Larger prospective studies incorporating long-term and quality-of-life outcomes are needed. Full article
(This article belongs to the Special Issue Radical Pelvic Surgery and Reconstructive Innovations in Pelvic Oncology)
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