Pelvic exenteration

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

These include:

• Cancers of the cervix, uterus, vulva 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

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 type of pelvic exenteration performed depends on the cancer’s location.

• Total exenteration removes the bladder and rectum
• Anterior exenteration removes the bladder with the gynecologic organs but leaves the rectum
• Posterior exenteration removes the rectum with the gynecologic organs but leaves the bladder in place

A pelvic exenteration is a major operation. Your doctor and other members of your cancer care team can help you decide whether this surgery is appropriate for you.

Six ways to prepare for a pelvic exenteration

Ahead of the procedure, there are several steps you can take to prepare for a pelvic exenteration.

• Write down any questions you have. Before surgery, you’ll 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 person you meet with can help explain what you’ll go through during and after surgery. Writing down your questions for each person may help you get the most out of your time.
• Find resources. Ask about emotional resources available to help you better understand the surgery and cope with the life changes it may bring. Your care team can share more information about this. You may want to speak with someone who has had the same surgery. Also, ask your care team about any sexual functions that may be affected by the surgery.
• Expect tests. Be prepared to undergo several medical tests to make sure you’re fit enough for pelvic exenteration. These may include:
  • Blood tests
  • Computed tomography (CT) scan or magnetic resonance imaging (MRI) 
  • Heart and lung function tests
• Know your medications. Let your care team know of all medications, herbal remedies and supplements you use, including those that are over the counter. They may want you 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 of bleeding.
• Learn about stoma care. A stoma is an opening you’ll have in the abdomen to help direct the flow of urine or stool into a special bag on the outside of your body. Your care team will explain how this works and how to care for your stoma and bag.
• Ask whether you need to follow a clear liquid diet the day before surgery. Your care team can give you instructions on what you can have with a clear liquid diet. You also may need to do special preparations to clear your bowel.

What to expect from a pelvic exenteration

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, you receive anesthesia for your comfort.

Your surgeon first needs to make sure you have “clear surgical margins,” meaning the cancer hasn’t spread outside the pelvis. Your 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, your care team may recommend other treatments.

If the samples don’t have cancer cells, your surgeon can 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 your surgeon's preferences.

After the removal, the surgeon proceeds to the reconstruction part. 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, your surgeon will perform a colostomy to make another way for stool to leave the body.
• If the bladder is removed, your surgeon will create a urinary diversion so urine can leave your body in a different way.
• If the vagina was removed, then vaginal reconstruction can help restore its function and structure, if desired.

The surgery typically takes about eight to 10 hours.

Benefits and risks of a pelvic exenteration

The benefit of a pelvic exenteration is that it may rid the body of the cancer that was contained in the pelvis. It can also help you to feel better and improve your quality of life.

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

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

Long-term side effects of a pelvic exenteration 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

Your care team may help you 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

Your care team can let you know whether the surgery was successful in removing cancer from your organs.

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