OBJECTIVE: Pelvic exenteration is a radical surgery for advanced or recurrent pelvic tumors, requiring careful patient selection and a multi-disciplinary approach. Despite advancements, it remains high-risk, with limited data on outcomes. The present meta-analysis evaluates survival, mortality, and trends to clarify its role in gynecologic oncology. METHODS: A systematic search was conducted in January 2025 to identify studies on pelvic exenteration outcomes for gynecologic malignancies. Studies with at least 10 patients reporting 5-year overall survival or 30-day mortality were included. Data extracted included patient and surgical characteristics, and a scoring system based on study design, sample size, and center volume was used to include high-quality studies (score ≥3). Poisson regression models were used to analyze the associations between predictors and outcomes, with results expressed as incidence rate ratios and a 95% CI. RESULTS: A total of 46 studies involving 4417 patients met the inclusion criteria. Most patients underwent pelvic exenteration for cervical cancer (N = 3183). Positive pelvic and aortic nodal involvement were key predictors of reduced 5-year overall survival, decreasing by 3.9% and 5.9% per 1% increase in nodal positivity, respectively. Pelvic wall involvement also significantly reduced survival by 15.9%. The 30-day mortality rate was 5.1%, with sepsis (27.2%) being the leading cause of death. Peri-operative mortality decreased significantly over time, with each year of publication associated with a 2.6% decrease in incidence rate. However, pelvic sidewall involvement and total exenteration increased 30-day mortality by 11.5% and 0.7%, respectively. CONCLUSIONS: Pelvic exenteration remains a viable but high-risk option for select patients with advanced gynecologic malignancies. Pre-operative assessment and multi-disciplinary planning are essential for optimizing outcomes.

Azienda Sanitaria Universitaria Friuli Centrale University Hospital Santa Maria della Misericordia Clinic of Obstetrics and Gynecology Udine Italy; University of Udine Department of Medicine Udine Italy

Charles University General University Hospital Prague 1st Faculty of Medicine Department of Obstetrics and Gynecology Prague Czech Republic

Fondazione IRCCS Istituto Nazionale dei Tumori Gynecological Oncology Unit Milan Italy

IRCCS European Institute of Oncology Division of Gynecologic Oncology Milan Italy; Sapienza University of Rome Department of Experimental Medicine Rome Italy

IRCCS Fondazione Policlinico Universitario Agostino Gemelli del Bambino e di Sanità Pubblica Dipartimento Scienze della Salute della Donna Rome Italy; Università Cattolica del Sacro Cuore Dipartimento Scienze della Vita e Sanità Pubblica Rome Italy

Memorial Sloan Kettering Cancer Center Department of Surgery Gynecology Service New York NY USA

Padova University Hospital Department of Gynaecology and Obstetrics Division of Women's and Children Health Padova Italy

Sapienza University of Rome Sant'Andrea Hospital Department of Surgical and Medical Sciences and Translational Medicine Unit of Gynecology Rome Italy

University of Manchester Division of Informatics Imaging and Data Sciences Manchester UK

University of Palermo Department of Gynecologic Oncology Palermo Italy; Fondazione G Pascale IRCCS National Cancer Institute Unit of Gynecologic Oncology Naples Italy

University of Rome Campus Bio Medico Department of Obstetrics and Gynaecology Rome Italy

University Sapienza of Roma Department of Obstetrics and Gynecology Rome Italy

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