Incorporating textbook outcomes in the audit of pelvic exenterations

Locally advanced pelvic tumors often require pelvic exenteration (PE) to achieve R0 resection, highlighting the critical role of specialized centers and nuanced metrics like textbook outcomes in assessing surgical performance and improving patient outcomes. This study aimed to audit our PE cases and compare the results with those reported by the PE Collaborative Group (PelvEx). Data were collected on patient demographics, tumor characteristics, diagnostic and treatment details, pathology findings, and outcomes. Both a direct audit and an evaluation based on the textbook outcomes were conducted. A comparison of our 23 PE cases with the PelvEx cohort, which exhibited comparable characteristics, revealed a higher rate of radicality in our cases but worse outcomes regarding hospital stay duration and mortality. However, approximately 65% of our patients achieved textbook outcomes, with over 90% meeting the criteria for both radicality and hospital survival. The incorporation of textbook outcomes into the audit of surgical procedures offers a valuable framework for clarifying the interpretation of direct audit results.