Quality improvement in exenteration for advanced pelvic malignancy: the role of a registry

Pelvic exenteration, once regarded as an 'extreme option for hopeless cases', has evolved into a standard of care for selected patients with advanced or recurrent pelvic malignancy. Parallel to technical and peri-operative advances, there has been a global shift towards structured quality improvement and registry-based outcome measurement. This paper outlines the historical evolution of exenterative surgery, the development of surgical quality registries, and their role in benchmarking performance. It highlights the success of international collaboratives such as PelvEx in standardising definitions and outcomes, and proposes a core dataset of key performance indicators (KPIs) relevant to exenterative surgery. These include oncological, peri-operative, and survivorship outcomes, supported by appropriate risk stratification. Establishing high-quality, prospectively maintained registries enables meaningful comparison between units, facilitates clinical governance, and strengthens advocacy for resources. Ultimately, registry-driven data are essential to refining surgical quality, optimising patient selection, and improving long-term survivorship in this complex patient cohort. This is particularly relevant with the variations in neo-adjuvant therapies.