Pelvic exenteration

This page was reviewed under our medical and editorial policy by

Ruchi Garg, MD, Chair, Gynecologic Oncology, City of Hope Atlanta, Chicago and Phoenix

This page was reviewed on January 12, 2022.

A pelvic exenteration is a surgical procedure that removes gastrointestinal, gynecological and urinary organs to treat certain types of advanced and recurrent cancers of the pelvic region.

A pelvic exenteration is a major operation. The patient's doctor and other members of his or her cancer care team may help the patient decide whether this surgery is appropriate.

Cancers that may be addressed using pelvic exenteration include:

  • Cancers of the cervix, uterusvulva or vagina 
  • Cancer that has spread from the colon or rectum to other organs within the pelvis
  • Cancer that has returned in the pelvic area after radiation therapy treatment

Pelvic exenteration surgery types

In females, the reproductive organs removed during a pelvic exenteration are the:

  • Cervix
  • Fallopian tubes
  • Ovaries
  • Uterus
  • Vagina
  • Vulva (in some women who have cervical, vaginal or vulvar cancer)

In males, the prostate and seminal vesicles (a pair of glands in the male pelvic area) are removed.

Other organs that may be removed with a pelvic exenteration include the:

  • Anus
  • Bladder
  • Colon
  • Rectum
  • Lymph nodes in the pelvis

The surgeon recommends the specific type of pelvic exenteration depending on where the cancer cells are located.

Total pelvic exenteration

During a total exenteration, the surgeon removes the bladder and rectum in addition to the reproductive organs.

Anterior pelvic exenteration

During an anterior exenteration, the surgeon removes the bladder with the gynecologic organs but leaves the rectum intact.

Posterior pelvic exenteration

During a posterior pelvic exenteration, the surgeon removes the rectum with the gynecologic organs but leaves the bladder in place.

Six ways to prepare for a pelvic exenteration

Ahead of the procedure, several steps are recommended to help patients prepare for a pelvic exenteration.

Write down any questions: Before surgery, the patient will likely meet with several health care professionals, including a surgical team (which may include a gynecologic oncologist, urologist, colorectal or surgical oncologists and/or a plastic surgeon), a psychologist and a wound/ostomy nurse. Each clinician may help explain what the patient will go through during and after surgery. Writing down questions for each person may help the patient get the most out of his or her time.

Find resources: Ask about emotional support resources available to help understand the surgery and cope with the life changes it may bring. The care team can share more information about this. The patient may want to speak with someone who has had the same surgery. Also, ask the care team about any sexual functions that may be affected by the surgery.

Expect tests: The patient should be prepared to undergo several medical tests to make sure he or she is fit enough for pelvic exenteration. These may include:

Discuss current medications: Let the care team know about all medications, herbal remedies and supplements the patient uses, including those that are over the counter. They may want the patient to stop certain medications in the days before the surgery. For example, non-steroidal anti-inflammatory drugs (such as ibuprofen or aspirin) may increase the risk for bleeding.

Learn about stoma care: A stoma is an opening the patient will have in the abdomen to help direct the flow of urine or stool into a special bag on the outside of the body. The care team will explain how this works and how to care for the stoma and bag.

Ask whether a clear liquid diet is necessary the day before surgery: The care team can provide instructions on what the patient can consume with a clear liquid diet. The patient also may need to do special preparations to clear his or her bowel.

What to expect during pelvic exenteration surgery

A pelvic exenteration is done in two parts. The first part of the surgery focuses on the removal of certain organs. The second part focuses on the reconstruction of some of the organs that were removed.

Before the surgery, the patient receives anesthesia for comfort.

The surgeon first needs to make sure the patient has “clear surgical margins,” meaning the cancer hasn’t spread outside the pelvis. The surgeon may first make small cuts into the abdomen to examine the organs and pelvic area. The surgeon may take tissue samples from certain areas beyond the pelvis to study under a microscope in the operating room. The surgery will not continue if these samples contain cancer cells, which means the cancer has spread beyond the pelvic area. In this case, the care team may recommend other treatments.

If the samples don’t have cancer cells, the surgeon may continue with the procedure.

Next, the surgeon checks whether total removal of the tumor appears possible and, if so, then the reproductive organs and other areas are excised. This part of the surgery can be performed through a minimally invasive or larger incision approach, depending on the surgeon's preferences.

After the removal, the surgeon proceeds to reconstruction. The areas of reconstruction are dependent upon which organs the surgeon removed. For example:

  • If the rectum, part of the colon, or both are removed, the surgeon performs a colostomy to make another way for stool to leave the body.
  • If the bladder is removed, the surgeon creates a urinary diversion so urine can leave the body in a different way.
  • If the vagina is removed, then vaginal reconstruction may help restore its function and structure, if desired.

The surgery typically takes about eight hours to 10 hours.

Benefits and risks of a pelvic exenteration

The benefit of a pelvic exenteration is that it may rid the body of cancer in the pelvis. It may also help the patient feel better and improve his or her quality of life.

However, some risks are associated with a pelvic exenteration, as with any type of surgery. These possible side effects and risks include:

  • Bleeding
  • Blood clots
  • Fluid buildup in the lungs
  • Pain
  • Pneumonia
  • Poor healing in the wound area
  • Ostomy issues

Long-term side effects of a pelvic exenteration may include:

  • Intestinal blockage caused by scar tissue
  • Fistula (abnormal connection between two body parts)
  • Kidney failure or infection
  • Lymphedema (fluid buildup in abdomen or legs)
  • Sexuality problems
  • Trouble with body image and self-esteem

The care team may help the patient manage these potential side effects.

It may take up to six months to fully recover from a pelvic exenteration.

Reviewing the results of a pelvic exenteration

The care team may let the patient know whether the surgery was successful in removing cancer from his or her organs.

Make sure to keep follow-up appointments with the care team to check on progress and find out any results from the surgery. Follow-up appointments are often scheduled two weeks to six weeks after surgery to check on recovery.

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