Postoperative Morbidity and Long-Term Survival After Total Pelvic Exenteration for Pelvic Malignancy: A Multicenter Retrospective Cohort Study

Background: Total pelvic exenteration (TPE) is a surgical procedure for locally advanced or recurrent pelvic malignancies and remains associated with substantial morbidity. This study aimed to evaluate major postoperative complications and to explore perioperative factors associated with their occurrence, as well as their clinical consequences and long-term survival. Methods: We conducted a retrospective multicenter study of patients who underwent TPE for malignant disease between 2014 and 2025 at four centers in France and Morocco. Patients were divided according to complication severity into major complications (Clavien–Dindo grade ≥3) and no major complications (grade <3). Clinical and survival data were collected. Overall survival was analyzed using Kaplan–Meier methods and compared using the log-rank test. Results: Fifty-four patients were included (21 women (38.9%) and 33 men (61.1%)), of whom 21 (38.9%) experienced a major postoperative complication. No significant differences were observed between groups regarding tumor origin, metastatic status, or neoadjuvant treatment. Bone resection was more frequent in patients with major complications (19.0% vs. 0%; p = 0.019). Major complications were associated with a longer median hospital stay (31 vs. 19 days; p = 0.0004) and more surgical reintervention (28.6% vs. 0%; p = 0.006). The 90-day postoperative mortality rate was 5.6%, with no difference between groups. During follow-up, 27 patients died. Median overall survival was 1273 days in the major complication group and 2043 days in the no major complication group, with no difference (p = 0.089). No statistically significant difference was found in disease-free survival. Conclusions: TPE is associated with substantial postoperative morbidity. Bone resection was associated with major postoperative complications, while major complications were associated with prolonged hospitalization and increased surgical reintervention. Management in experienced centers may be important for prompt complication management.