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It is performed in patients with cancers in organs that have spread in the pelvic region.
A total pelvic exenteration or pelvic clearance surgery is the surgical procedure to remove
- The bladder.
- The uterus (womb).
- The ovaries.
- All or part of your vagina.
- The rectum and anus (part of the lower intestine).
It is performed in patients with cancers of the above organs that have spread in the pelvic region.
The procedure is usually done under general anesthesia:
- An incision (cut) will be made in the middle of the abdomen from the belly button to the top of the pubic bone.
- Sometimes, it may also be necessary to make a second incision around the anal area to carry out the operation.
- The affected organs such as the bladder and lower bowel are usually removed.
- Once removed, two permanent openings called stomata are made. It is usually created on the abdominal wall to divert and drain urine and feces into a bag.
- Usually, a plastic surgeon would be involved in the operation to repair the changes made by the surgery by using a flap to make the repair.
What are the types of a pelvic exenteration?
A pelvic exenteration can be carried in three different ways depending on the cancer location:
- An anterior exenteration: It removes the bladder but not the rectum. It is done if there is no cancer in or close to the rectum.
- A posterior exenteration: It removes the rectum but not the bladder. It is done if there is no cancer in or close to the bladder.
- A total exenteration: It removes both the bladder and rectum.
Why is a total pelvic exenteration performed?
A pelvic exenteration is used when cancer has spread within the pelvis or has come back in the pelvis after other treatments. It is most often used to treat cervical cancer that has come back after treatment. This operation can be done to treat cancers in the pelvis including:
- Cervical cancer
- Womb cancer
- Vaginal cancer
- Vulval cancer
- Rectal cancer
- Anal cancer
- Prostate cancer in men
Is total pelvic exenteration a major surgery?
A pelvic exenteration is a major operation. It is an open procedure and usually takes around 8-10 hours to complete. The average length of the stay in the hospital is 10-14 days after the procedure. There are risks associated with the procedure. Possible risks and complications from this surgery are as follows:
- Bleeding
- Blood clots
- Problems due to general anesthesia such as dizziness, headaches, and vomiting
- Infections and slow wound healing
- Joining inside of the bowel or stoma could come apart
- Joining tubes coming from the kidneys could come apart
- A hole called a fistula can occur in the pelvis or abdomen due to having cancer treatments
- Bowel could get obstructed
- The kidneys could start to fail
- Reconstruction tissue may begin to break down
What is the survival rate of a patient after a total pelvic exenteration?
As per research, the survival rate is considered poor in a total pelvic exenteration, despite improvements in the technique. Multiple non-modifiable factors at the time of an exenteration are associated with poor survival.