April 14, 2026
Complex pelvic tumors are challenging to treat, often due to the location of the mass, limited access to the tumor and the high density of important structures in the pelvis. As a high-volume referral center, Mayo Clinic has experience treating complex pelvic masses, particularly recurrent rectal cancer.
"These types of rare tumors should be seen at a center that has the expertise and resources to treat them," says Dorin T. Colibaseanu, M.D., a colon and rectal surgeon at Mayo Clinic in Jacksonville, Florida. "There's a lot of high-value real estate in the small area where these pelvic masses occur. We tend to see tumors that were assessed elsewhere and deemed unresectable."
Recurrent rectal cancer is treated only in a limited number of institutions that have the resources, multidisciplinary expertise and necessary coordination. Dr. Colibaseanu and other colorectal surgeons at Mayo Clinic combine data from patients treated across their three campuses to outline a treatment guide for recurrent rectal cancer.
According to Dr. Colibaseanu, overcoming the challenges associated with treating complex pelvic tumors involves three critical components:
- A collaborative, multidisciplinary approach.
- Imaging and surgical techniques.
- Comprehensive postoperative care.
Collaborative approach to recurrent rectal cancer and complex pelvic tumors
Due to their location in a crowded space, locally advanced pelvic tumors require a treatment approach involving multiple specialists. Collaboration begins in the preoperative planning stage and continues through postoperative care.
In addition to the standard tumor board comprising colorectal surgeons, oncologists, pathologists and radiologists, complex pelvic tumor management typically requires an expanded team of specialists. Treatment is personalized to include oncological therapies before and after surgery, as well as intraoperative radiation therapy administered directly to the pelvic cavity.
"Many of the tumors we treat either invade or are densely attached to critical structures," Dr. Colibaseanu says. "Because of that, close collaboration is integral when making care decisions. It's rare for us to have fewer than three surgical specialties working together."
Dr. Colibaseanu refers to the removal of pelvic sarcoma as an example. The operation is performed by a team that includes a colorectal surgeon, urologist, orthopedic surgeon and plastic surgeon. "While pelvic sarcoma is very rare, this is not exceptionally rare for us," Dr. Colibaseanu says. He has operated on two patients with pelvic sarcoma within three months.
Advanced imaging and surgical techniques for pelvic masses
Imaging is essential to addressing challenges associated with tumor location and access. The surgical team relies on specialized pelvic cancer radiologists and the latest MRI technology to provide precise imaging.
"There are two factors involved in high-level imaging," Dr. Colibaseanu says. "One is the specialization of the radiologist who directs and reads the imaging. The second is the technology itself. The MRI technology we use is always the most advanced available."
The surgeries are typically long and are sometimes performed over two days, using a robotic platform when possible. Advanced surgical techniques such as robotic surgery can help address the challenges associated with a technically demanding resection and operating in a cramped pelvic region.
"When you are treating complex pelvic tumors and recurrent rectal cancer, ongoing collaboration within our team is key."
Dr. Colibaseanu was part of a research team that was among the first to demonstrate significant short-term benefits of robotic rectal cancer surgery over laparoscopy in a large cohort of patients. The 2021 study, published in Annals of Surgery, showed that patients undergoing robotic surgery were 51% less likely to experience a complication and 38% less likely to be hospitalized for six or more days compared with those who had laparoscopic surgery.
Complex major surgeries are typically associated with higher complication rates. However, specialized centers show lower postoperative complication rates.
Part of that may be due to advanced surgical techniques at specialized centers. Dr. Colibaseanu says that regardless of the surgical technique used, lower postoperative complication rates often depend on expert and collaborative perioperative care.
"Treating complex pelvic tumors is about more than just the surgery itself," Dr. Colibaseanu says. "How the patient is managed perioperatively plays a significant role in long-term outcomes."
Postoperative care following surgery for recurrent rectal cancer is complex. Enhanced recovery protocols are strongly associated with improved short-term outcomes following surgery. To manage complications, all surgical specialties involved in the case conduct follow-ups and round together. Patients receive postoperative care in a focused colorectal recovery unit, where specially trained nurses care only for these patients.
"When you are treating complex pelvic tumors and recurrent rectal cancer, ongoing collaboration within our team is key," Dr. Colibaseanu says. "We make decisions about each patient's care as a team before, during and after surgery to ensure the best possible outcomes."
For more information
Crippa J, et al. Robotic surgery for rectal cancer provides advantageous outcomes over laparoscopic approach: Results from a large retrospective cohort. Annals of Surgery. 2021;274:e1218.
Refer a patient to Mayo Clinic.