What is a Pelvic Exenteration?

D. Jeffress

A pelvic exenteration is a major surgical procedure that involves removing most or all of the organs found in the pelvic region. It is typically reserved for severe, recurring cancers that do not respond to minor surgeries, radiation, or chemotherapy. The small and large intestine are realigned to bypass the pelvis and expel waste through surgical openings in the abdomen. Pelvic exenteration is most commonly performed on females with cervical cancer, though a male patient with severe prostate or rectal cancer may also be a candidate.

An X-ray of the pelvis.
An X-ray of the pelvis.

Doctors exhaust all other cancer therapy options before considering pelvic exenteration. Cervical cancers and other malignancies in the region that persist despite aggressive treatment are usually fatal, and removing organs may be the final hope for sufferers. There are three general types of pelvic exenteration: anterior, posterior, and total. The bladder, urethra, and female reproductive organs are removed in an anterior procedure, and the rectum and reproductive organs are cut out during posterior surgery. Total exenteration involves the removal of all organs, tendons, muscles, and fat tissue in the pelvic region.

Pelvic exenteration is major surgery for severe, recurring cancers.
Pelvic exenteration is major surgery for severe, recurring cancers.

The procedure is usually performed in about three hours while the patient is kept under general anesthesia. A surgeon makes a long incision along the lower abdomen and proceeds to carefully remove the appropriate structures. If the bladder is removed, a hole called a stoma is made in the abdomen and connected to the kidneys so urine can be directly expelled from the body. Another stoma to empty the large intestine is created if the rectum is removed. Pouches are connected to each stoma to collect waste.

Immediately following pelvic exenteration, a patient is admitted into a hospital room so doctors and nurses can monitor recovery. A stomach tube is usually inserted to prevent food and liquid from entering the bowels for a few days. Nurses dress and clean surgical scars and stomas. A patient is typically instructed to stay in bed for about three days, and then gradually start walking around to rebuild strength. Most patients are allowed to go home about two weeks after their surgeries.

Pelvic exenteration can significantly change a person's life. Women stop menstruating and become infertile, and many men lose the ability to get erections. Waste-collecting pouches must be worn at all times underneath the clothes and changed regularly. With practice, support, and a positive attitude, a person can learn to overcome physical limitations and adjust to lifestyle changes after surgery.

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