Pelvic Exenteration

What is pelvic exenteration?

Pelvic exenteration is surgery to treat cancer of your reproductive organs. Healthcare providers usually perform this procedure on people designated female at birth (DFAB). But it’s possible for people designated male at birth (DMAB) to have pelvic exenteration, too.

In most cases, your surgeon removes your vagina, uterus and cervix during this operation. They may also remove organs that are part of your urinary tract and digestive tract. These may include your bladder and part of your intestine.

Before recommending this major surgery, healthcare providers try other cancer treatments. These include chemotherapy, radiation and surgery to remove tumors. If these treatments don’t work or the cancer comes back, your healthcare provider may recommend a pelvic exenteration.

This procedure relieves cancer pain and can cure cancer. But there’s a risk of complications and recovery can be challenging. Talk to your healthcare provider about the risks, benefits and recovery time involved with this surgery.

What are the types of pelvic exenteration?

There are three types of female pelvic exenteration: anterior, posterior and total. Your healthcare provider will recommend the procedure that’s right for you based on where the cancer has spread. All types include removing organs from your reproductive system, including your:

• Cervix, the opening of your uterus.
• Fallopian tubes, which go from your ovaries to your uterus. Eggs travel through your fallopian tubes to your uterus.
• Ovaries, which make eggs. During your monthly menstrual cycle (period), an ovary releases an egg.
• Uterus, the organ where a developing baby grows.
• Vagina, a muscular tube that starts at your vulva (your external genitals) and extends to your cervix.

In an anterior pelvic exenteration, surgeons remove your bladder, as well as your reproductive organs.

In a posterior pelvic exenteration, surgeons remove a portion of your intestines and your reproductive organs.

In a total pelvic exenteration, healthcare providers remove your reproductive organs and the organs in your urinary system and digestive system. These include your:

• Anus, the opening that carries stool (poop) out of your body.
• Bladder, the muscular pouch that collects urine (pee).
• Colon, the longest part of your large intestine.
• Rectum, the last few inches of your large intestine.
• Urethra, the tube that carries urine out of your body.

Why do providers perform pelvic exenteration?

Pelvic exenteration is a major operation. Healthcare providers only recommend it if other treatments haven’t worked or if the cancer has spread to several organs in your pelvis.

This operation treats cancer of the female reproductive system, also called gynecological cancer. You may need this surgery if you have gynecological cancer that doesn’t go away after radiation therapy, chemotherapy or surgery. Gynecological cancers that may be treated with this surgery include:

• Vaginal cancer.
• Uterine cancer.
• Cervical cancer.
• Vulvar cancer.

Healthcare providers also perform pelvic exenteration on people designated male at birth (DFAB) to treat recurring pelvic cancer, such as urethral cancer. In this procedure, surgeons remove your bladder, rectum, anus and part of your intestine. They also remove your:

• Prostate, a walnut-sized gland that’s part of your reproductive system.
• Seminal vesicles, glands that secrete fluid that makes up semen.
• Urethra, the tube that carries urine out of your body.

How common is pelvic exenteration?

Healthcare providers don’t perform this procedure often. Usually, other cancer treatments and surgeries are effective at treating specific types of gynecological cancers. For example, healthcare providers may recommend a vaginectomy (removing part of your vagina) for recurring (comes back) vaginal cancer. Or they may suggest a hysterectomy for uterine cancer.

What happens before pelvic exenteration?

Before surgery, your healthcare provider will do a thorough examination. They may order imaging tests, such as an MRI and CT scan, to see pictures of your pelvic organs. The images help them plan the surgery.

To prepare for the procedure, you may need to stop taking certain medications like blood thinners. You’ll also need to avoid eating or drinking anything the night before the surgery. Ask your healthcare provider about other preparations you may need.

What happens during pelvic exenteration?

Your healthcare provider will give you general anesthesia through a vein in your arm. You’ll be asleep throughout the procedure and won’t feel pain during surgery. Procedure details depend on the type of pelvic exenteration your healthcare provider recommends. They’ll make several incisions (cuts) to remove reproductive organs and other organs as necessary. Or, your healthcare provider may recommend a minimally-invasive procedure that requires smaller incisions.

If your healthcare provider removed your bladder and urethra, they’ll make a new way for urine to leave your body. They may create a new bladder using a piece of your intestine. Or, they may connect your kidneys and ureters (tubes that carry urine) to a small hole (urostomy) in your abdominal wall. The urine either collects in a bag, or sometimes, you can insert a catheter (thin tube) into the hole to remove waste.

If you had your colon, rectum and anus removed, your healthcare provider will create a new way for feces (poop) to leave your body. They may attach the remaining part of your intestine to your abdominal wall and create an opening (colostomy). You attach a bag to this new opening to collect and dispose of feces. The entire procedure usually takes around 12 hours.

What happens after pelvic exenteration?

Your stay in the hospital will be long. Some people even need to stay in the hospital for several weeks. Your healthcare provider will monitor your health and give you medications to relieve pain.

Some people choose to have a vaginoplasty immediately following pelvic exenteration. This is surgery to reconstruct your vagina. If you’re interested in this procedure, talk to your healthcare provider.

While you’re healing, your healthcare provider will tell you how to take care of your incisions. They’ll also teach you how to care for your colostomy and urostomy if you have them. Follow your healthcare provider’s instructions carefully to avoid complications.

What are the advantages of pelvic exenteration?

This procedure is effective at relieving pelvic pain that results from recurring (returning) cancer. It can cure cancer of your reproductive organs when other treatments haven’t worked, or the cancer has returned after treatment.

What are the risks or complications of pelvic exenteration?

There are risks involved with pelvic exenteration. Although uncommon, there’s a risk of death following this procedure. Other risks include:

• Bowel obstruction (where your intestines are blocked and food doesn’t pass normally).
• Infection.
• Problems with the ostomies (new holes your healthcare provider created to let urine and waste leave your body).
• Sepsis (an infection that’s spread into your bloodstream).
• Severe bleeding or blood clots.
• Swelling, redness, irritation or opening of the incisions.
• Vaginal fistula (a hole between your vaginal area and other internal organs, such as your bladder).

What is the recovery time after pelvic exenteration?

It’s essential to rest and avoid physical activity for several weeks after surgery. A family member or friend will need to help you with bathing, dressing and moving around until you feel better. Talk to your healthcare provider about what activities (including sexual activity) you should avoid and when you can start them again.

Depending on the type of procedure you had, you may not be able to sit down for up to eight weeks. You’ll be able to stand up and lie on your back or side. But standing or walking for long periods of time may be difficult.

Some people find it challenging to sit up straight for several months, or years, following the procedure. This is because your surgeon removed many organs and tissues that provided structure to your abdomen. Ask your healthcare provider about physical therapy and exercises you can do to improve your core (stomach area) strength. Many people also benefit from counseling, support groups and connecting with others who’ve been through this surgery.

When should I see my healthcare provider after pelvic exenteration?

Following surgery, you’ll have regular check-ups with your healthcare provider. Call them right away if you have:

• Bleeding or swelling in your abdominal area.
• Fever, redness and swelling near the incision (these are signs of infection).
• Severe abdominal pain.
• Urinary incontinence, fecal incontinence or any problems getting rid of waste (pee or poop).
• Nausea and vomiting.
• Constipation.

A note from Cleveland Clinic

Pelvic exenteration can relieve pain that results from pelvic cancer. This surgery can help people who have cancer that comes back or doesn’t respond to other treatments. But there are many risks involved with this major operation. Talk to your healthcare provider about these risks, as well as the benefits. It’s important to have an honest and realistic discussion when deciding whether this procedure is right for you.