Waters PS, et al. - The changes in exenterative surgery over three decades analyzing oncological outcomes were investigated. In addition, researchers determined if changes in surgical approach have led to improved patient outcomes. Prospectively maintained databases of pelvic exenteration surgery from 1988 to 2018 at two high volume specialized institutions and division of the total cohort was done into three major time points (1988–2004, 2005–2010 and 2011 to 2018) to allow comparative analysis. They identified 670 patients who underwent exenterative surgery. They noted a rise in resection of recurrent malignancy with a continuous rise in GI malignancies resected over each time period and a reduction in gynecological malignancy in 2011–2018. Sacrectomy, pelvic sidewall resection, and ileal conduit reconstruction increased significantly. Increased rates of ileus and anastomotic leak were reported in patients in 2005–2010. Patients undergoing pelvic exenteration surgery from primary disease showed a significant improvement in survival. They noted an increase in case complexity without significant morbidity.