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The synchronous abdomino‐perineal pelvic exenteration performed by the majority of exenterative units today was adapted from the technique for LARC described by Schmitz (Chicago, USA) in 1959 [42]. Over time it was recognized that the malignancy did not always extend to all of the adjacent pelvic organs. Consequently, partial exenteration was described, preserving urinary and/or rectal function. The later part of the twentieth century also saw the intensification of surgical subspecialization, driven in part by returning surgical veterans from World War II who had gained experience in specialties such as orthopedics and plastic and reconstructive surgery. The rapid subspecialization that ensued, combined with major advances in perioperative care, including intensive care and cardiac monitoring contributed to the progress seen in exenterative surgery (Figure 1.3) [2].

Figure 1.3 Evolution of pelvic exenterative surgery.