Pelvic exenteration is a long surgery and typically takes 8 hours or longer.
Pelvic exenteration is a surgical procedure performed for centrally located recurrent gynecologic cancers involving resection (removal) of all pelvic structures, including the uterus, cervix, vagina, bladder, and rectum. Pelvic exenteration is a long surgery and typically takes 8 hours or longer.
Why is pelvic exenteration done?
The surgery is most commonly indicated for recurrent cervical cancer, but patients with recurrent uterine, vulvar, or vaginal cancers may also benefit from pelvic exenteration. Pelvic exenteration is not ideal to treat ovarian cancer because ovarian cancer is often associated with distant spread across the body (metastasis). Pelvic cancers usually require multimodality treatment, including surgical resection and radiation. Pelvic exenteration is usually indicated when other surgical procedures, radiation, and chemotherapy fail to completely cure the cancer and there is recurrence.
How is pelvic exenteration performed?
The surgery is performed under general anesthesia. The surgery is long, takes over 8 hours, and usually involves a team of surgeons.
There are three types of pelvic exenteration:
- Anterior pelvic exenteration: Removal of all the reproductive organs and the bladder.
- Posterior pelvic exenteration: Removal of all the reproductive organs and the bowel.
- Total exenteration: Removal of all the reproductive organs and the bladder, urethra, rectum, anus, and colon.
Following pelvic exenteration, reconstructive surgery would be performed. There would be the placement of ostomies (holes) connected to an external pouch for urination and defecating. The women may have surgery to reconstruct a vagina. The new vagina is called a "neovagina.”
What happens after pelvic exenteration?
Patients typically stay in the hospital for 7 to 10 days after surgery. Medications to prevent blood clots, infection, pain, and constipation would be prescribed. Early walking and chest physiotherapy would be performed to prevent blood clots in the blood vessels and pneumonia. If vaginal reconstruction is done, the patient would be unable to sit for 6-8 weeks but they would be able to lie on the side or stand. Surgical incisions should be kept clean and dry. The patients are advised to wear loose-fitting clothes made of breathable materials like cotton. Patients may walk and do simple activities that they can tolerate. Patients should avoid housework, lifting, sexual intercourse sports, and exercise including yoga or Pilates until the doctor approves. Complete recovery can take around 6 months or longer.
When to see a doctor:
The following require immediate medical attention:
- Nausea or vomiting
- New or worsening pain
- Worsening swelling or redness
- Wound opening
- Vaginal bleeding
- Urinary problems like burning or inability to pass urine through the pouch
- Wound pain, swelling, redness, discharge, and opening
What are the complications of pelvic exenteration?
Pelvic exenteration is major surgery. Some possible complications that may be encountered are:
- Blood loss
- Blood clots
- Edema (swelling)
- Blood clots with the blood vessels
- Reaction to anesthesia
- Fistula (abnormal communication between two body structures)
- Bowel obstruction
- Blood clots
- Necrosis (tissue death) of flap used for reconstruction
- A decrease in quality of life