BJS, 2022, 109, 1023–1024 https://doi.org/10.1093/bjs/znac289 Advance Access Publication Date: 5 August 2022 Research Letter Advances in pelvic exenteration surgery can support clear margin resection for metastatic non-pelvic primary malignancies Benjamin Fernandez, Christina A. Fleming , Arthur Marichez, Paul Mauriac and Quentin Denost* Department of Colorectal Surgery, CHU Bordeaux, Bordeaux, France *Correspondence to: Quentin Denost, Department of Colorectal Surgery, Centre Medicochirurgical Magellan, 33600 Pessac, France (e-mail: quentin.denost@chu-bordeaux.fr) Received: June 06, 2022. Accepted: June 30, 2022 © The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com Dear Editor Surgical advances in pelvic exenteration (PE) have improved survival in patients with advanced and locally recurrent pelvic malignancy 1–3 . Surgical advances in PE, including minimally invasive surgery, higher and wider resections, improved training, and standardization of PE techniques, have all contributed to improved oncological outcomes. These developments have led to an increase in the complexity of cases that are successfully managed surgically, while balancing the intention of cure against the morbidity of surgery and quality-of-life implications 3,4 . A further potential beneft of these advancements may be the broadening of indications for surgery. Occasionally, non-pelvic tumours can metastasize to the pelvis. PE affords the opportunity to offer resectional surgery with curative intent for a broader repertoire of rare tumours, including non-intestinal and hepatobiliary malignancies. a T2 sagittal section d Rectum and hysterectomy specimen e Cut section b Coronal section c Axial section Fig. 1 Pelvic MRI and pathological specimens Pelvic MRI demonstrating a heterogeneous hypodense tumour in the pelvis: a T2 sagittal section, b coronal section demonstrating tumour extension to the piriform muscle, and c axial section demonstrating proximity of tumour to internal iliac vessels. Macroscopic pathological specimen of en bloc resected mass: d rectum and total hysterectomy with bilateral salpingo-oophorectomy and, e cut section demonstrating multilobed tumour.