In all, 5–15% of patients with advanced rectal cancer (LARC) who have resection will experience local recurrence while receiving multimodal treatment. Even with cutting-edge reconstructive surgery, the 5-year survival chances for locally recurrent rectal cancer (LRRC) remain dismal, at 25 to 50%. The cohort’s high local and systemic recurrence rates indicate the tumor types’ potential biological aggressiveness. For a study, researchers sought to evaluate the most recent research revealing pathological variables linked to tumor recurrence and survival in patients receiving exenterative surgery.

Following PRISMA criteria, a systematic analysis of all trials investigating pathological variables impacting survival after pelvic exenteration for LARC or LRRC from 2010 to July 2021 was conducted using the databases of MEDLINE, EMBASE, and COCHRANE Trials. QUIPS tool was used to evaluate bias risk.

Nine cohort studies that reported results for 2,864 patients satisfied the inclusion criteria. The considerable heterogeneity of reported results precluded meta-analysis. The most often mentioned criteria were nodal disease and resection margin status. About 6 investigations showed that a positive resection margin was a poor prognostic indicator. Lymphovascular invasion and involved lymph nodes also seem to be poor prognostic indicators, with tumor stage appearing to be less significant. No research examined other unfavorable tumor characteristics that a histopathology report wouldn’t typically mention.

Numerous studies showed that the condition of the pathological resection margins affected both disease-free and overall survival after pelvic exenteration for rectal cancer.