This month's paper looks at standardising the pathological reporting of pelvic exenterations - complex operations associated with significant morbidity and resource implications.
A standardised approach to the pathological dissection and reporting of pelvic exenteration specimens: Recommendations from the UK Pelvic Exenteration Network (UKPEN). J Aldridge, C. Young, J. Tiernan, A. Quyn, D. Tolan, J. T. Jenkins, E. Burns, A. Martinez, A. C. Bateman, A. Mirnezami, K. Boyle, C. Richards, G. Matthews, G. Kohnen & N. P. West. Colorectal Disease. 2026;28:e70433.
What is known about the subject?
Pelvic exenteration is a highly complex, resource-intensive procedure performed for locally advanced or recurrent pelvic malignancies, where achieving clear (R0) margins is the key determinant of oncological outcome. High-quality pathological assessment is essential for staging, prognostication, and audit. However, despite its importance, there has been no internationally agreed or standardised approach to the dissection and reporting of these complex multivisceral specimens, leading to heterogeneity in practice and limited comparability across centres.
What this study adds
This UK Pelvic Exenteration Network (UKPEN) consensus paper provides the first comprehensive, standardised framework for the pathological handling of pelvic exenteration specimens across the entire pathway. It emphasises:
- Integration of pathology into pre-operative planning, alongside radiology and surgery
- Standardised approaches to specimen orientation, inking, slicing, and photographic documentation
- Detailed and reproducible methods for margin assessment, including nuanced interpretation of lymph node involvement at margins
- Structured sampling protocols and microscopic reporting standards
- The importance of post-operative multidisciplinary correlation meetings for quality improvement
Importantly, the paper highlights unresolved areas such as the definition of R1 in locally recurrent rectal cancer underscoring the need for further research and consensus.
Implications for colorectal practice
This guidance reinforces that optimal outcomes after pelvic exenteration depend not only on surgical expertise but also on tightly integrated multidisciplinary workflows. For colorectal teams, it highlights the importance of embedding pathologists within the MDT process, ideally from pre-operative planning through to post-operative review. It also supports the adoption of standardised specimen handling and reporting protocols to improve margin assessment, reduce R1 rates, and enable meaningful audit. Furthermore, the use of structured pathology reporting can enhance radiological–surgical–pathological correlation, thereby supporting continuous service improvement. Finally, such standardisation facilitates national and international collaboration and research, which is particularly important in the context of rare and complex exenterative cases.