Pelvic exenteration

A pelvic exenteration is surgery that may be done to treat advanced cancer that has not spread outside the pelvis or cancer that has come back in the pelvis only. It is done only if there are no signs of cancer in another place in the body.

A pelvic exenteration may be done to treat:

• cancers of the female reproductive organs including cancer in the cervix, uterus, ovary, vagina and vulva
• cancer that has spread from the colon or rectum to nearby organs
• cancer that has come back in the pelvis after being treated with radiation therapy

A pelvic exenteration removes reproductive organs, the bladder or rectum or both, and lymph nodes in the pelvis. Sometimes part of the colon and anus are also removed.

• The female reproductive organs removed are the ovaries, fallopian tubes, uterus, cervix and vagina. The vulva may be removed in some women with cervical cancer.
• The male reproductive organs removed are the prostate and seminal vesicles.

An anterior exenteration removes the bladder but not the rectum. It is done if there is no cancer in or close to the rectum.

A posterior exenteration removes the rectum but not the bladder. It is done if there is no cancer in or close to the bladder.

A total exenteration removes both the bladder and rectum.

A pelvic exenteration is major, life-changing surgery. Your healthcare team will give you detailed information about it. They will also help prepare you for changes to your body and life after surgery. Treatment centres usually offer counselling and other services that provide emotional support to you and your family before and after the surgery.

You will have medical tests, such as blood tests and heart and lung function tests, to help your doctor decide if you are healthy enough to have the surgery. You will also have imaging tests, such as a CT scan or an MRI, to see if the cancer has spread outside the pelvis. If cancer is found outside the pelvis, a pelvic exenteration will not usually be done.

Find out more about tests and procedures that may be done before a pelvic exenteration.

A pelvic exenteration is done in the hospital using a general anesthetic (you will be unconscious). It is done in 2 stages. The first stage is removal, which is called exenteration or resection. The second stage is reconstruction.

Before removing any organs, the surgeon may make a few small incisions (surgical cuts) in the abdomen. The surgeon can use a laparoscope (a thin, tube-like instrument with a light and lens) to look inside the abdomen. This allows the surgeon to examine all the organs in the abdominal cavity and the pelvic structures.

Tissue samples are taken from all abnormal areas in the abdominal cavity and examined under a microscope in the lab while you are in the operating room. If the tissue samples contain cancer cells, the operation is stopped. If cancer cells are not found, the surgery can continue.

A larger cut is then made in the lower abdomen and pelvis. The surgeon looks to see if there are any signs of cancer in these areas that would prevent the surgery from continuing. Samples of lymph nodes may also be taken while you are in the operating room and examined to see if they contain cancer cells.

If the surgeon thinks that the tumour can be removed completely, the reproductive organs, the bladder or rectum or both, pelvic lymph nodes and supporting tissues in the pelvis are then removed. Sometimes part of the colon or anus is also removed.

Reconstruction is the second stage of the surgery. The type of reconstruction depends on which organs were removed.

A urinary diversion is a surgical procedure that creates a new way for the body to store and get rid of urine if the bladder is removed. Find out more about a urinary diversion.

A colostomy is a surgical procedure that creates a way for stool to leave the body if the rectum or part of the colon or both are removed. Find out more about a colostomy.

Vaginal reconstruction helps restore the structure and function of the vagina. Find out more about vaginal reconstruction.

It may take 6 months or longer for your body to recover from a pelvic exenteration. Your healthcare team will teach you how to care for yourself after the surgery. Your doctor will recommend tests, procedures, follow-up care or additional treatment that you need after a pelvic exenteration.

Adjusting to the changes to your body can take a year or more. Your healthcare team can arrange for care and support to help you and your family adjust to changes in your body and life.

Side effects can occur with any type of treatment, but not everyone has them or experiences them in the same way. Side effects of a pelvic exenteration will depend mainly on what was removed and your overall health.

Short-term side effects can happen during, immediately after or a few weeks after a pelvic exenteration. They are usually temporary. Short-term side effects of a pelvic exenteration include:

• pain
• blood clots in the legs or in the lungs
• bleeding
• infection
• poor wound healing
• poor healing resulting in leaking wherenormal structures in the pelvis are stitched (sutured) together
• pneumonia
• a buildup of fluid in the lungs

Long-term side effects can develop months or years after a pelvic exenteration and can last a long time. Long-term side effects of a pelvic exenteration include:

• a buildup of lymph fluid in the legs or abdomen because the lymph nodes in the pelvis were removed (called lymphedema)
• changes to self-esteem, body image and sexuality
• blockage of the intestine caused by bands of scar tissue (called adhesions)
• a fistula (an abnormal opening between normal structures, such as between the intestine and the vagina or the urinary tract and the intestine)
• kidney problems, such as infection or kidney failure
• urinary obstruction (blockage of the ureters)
• death of the tissues used to reconstruct the vagina or to make a stoma

This surgery can lead to sexual challenges because all the reproductive organs are removed.

• Men may be impotent if the nerves controlling erections are damaged or cut to remove the cancer.
• All women will be infertile (not able to become pregnant) because their uterus has been removed. Premenopausal women will experience treatment-induced menopause because their ovaries have been removed.

Find out more about sexual problems for men, sexual problems for women and treatment-induced menopause.

Talk to your healthcare team about any long-term side effects of a pelvic exenteration. They can also help you cope with changes to self-esteem and body image as well as sexuality and cancer.