BACKGROUND Surgery for locally advanced
rectal cancer with frozen pelvis is challenging. Therefore, we designed the "modular
pelvic exenteration" surgical strategy to achieve better radical resection. CASE REPORT A 51-year-old man with
rectal cancer refused surgery and received
chemotherapy and
radiotherapy. He was intolerant to
chemotherapy and did not respond well to
radiotherapy. With
cancer progression, he presented at our hospital with
emaciation,
fatigue,
dysuria, bloody urine, bloody stool, and anal
pain. Computed tomography and magnetic resonance imaging revealed the
rectal tumor involved multiple adjacent organs and caused rectovesical
fistula, bilateral
hydronephrosis, hydroureterosis, and local
pelvic infection. The
rectal tumor was fixed in the pelvic cavity, presenting a frozen pelvis pattern. There was no distant
metastasis. As the patient could not tolerate
chemotherapy, was unsuitable for immune-check point inhibitor because the
tumor had microsatellite stability, and did not respond well to
radiotherapy, surgical resection seemed the most suitable treatment option. After the patient's
anemia and
malnutrition improved, our designed modular
pelvic exenteration surgery was performed. In this strategy, we divided pelvic organs and tissues into 4 independent modules. After combining the modules planned to be resected, we delineated the pre-
resection margin. By this strategy, the
tumor was removed en bloc, with a clear
resection margin. The patient was discharged 13 days after the operation, without complications. Follow-up for 24 months revealed no signs of
tumor recurrence. CONCLUSIONS For locally advanced
rectal cancer with frozen pelvis, the modular
pelvic exenteration strategy may help to achieve satisfactory surgical effects in selected patients.