Pelvic Exenteration

Pelvic exenteration is a major surgery that treats advanced or recurrent cancers in your pelvis. Recurrent means the cancer has come back after treatment.

During this procedure, a surgeon removes tumors that have spread in your pelvis. They remove affected tissue, including organs. Usually, the procedure treats cancers of the female reproductive system, like cervical cancer. But it also treats colorectal, anal and bladder cancers.

This surgery can ease cancer pain. Sometimes, it cures cancer that hasn’t spread beyond the pelvis. But it’s a complex operation that carries risks and has a challenging recovery. So, healthcare providers only use it as a last resort or in very specific circumstances. They might suggest it when other treatments haven’t helped enough but there’s still a chance for a cure.

Types of pelvic exenteration

The type of procedure you need depends on the cancer's location in your pelvis and your sex. For gynecological cancers (affecting females), types include:

• Anterior (front) pelvic exenteration: Removes your reproductive organs, like your uterus, ovaries, cervix and vagina, and parts of your urinary system, like your bladder and urethra
• Posterior (back) pelvic exenteration: Removes your reproductive organs and digestive system organs, like your rectum, anus and parts of your colon
• Total pelvic exenteration: Removes your reproductive organs and impacted organs in your urinary and digestive systems

In males, total exenteration also removes the seminal vesicles and prostate.

How should I prepare for this procedure?

This is a major operation, which means you’ll get detailed instructions on how to prepare. Your healthcare provider may advise you on:

• Avoiding alcohol and tobacco
• Stopping certain medicines, like blood thinners
• Changing your eating or drinking habits before surgery
• Choosing someone to care for you during recovery
• Taking time off from work

Be sure to follow their instructions exactly. Don’t hesitate to ask questions if you’re unsure about what to do.

What happens during pelvic exenteration?

Most people need open surgery. A surgeon makes a large incision (cut) that allows them to access your pelvic cavity. Sometimes, surgeons use an approach called laparoscopy that makes smaller incisions.

First, you’ll get general anesthesia that puts you to sleep. You won’t feel any pain during the procedure. Your surgeon will remove the affected tissue and a margin of healthy tissue. This margin helps ensure no disease gets missed. Then, they’ll do procedures that allow you to live without the organs that were removed.

If your surgeon removed your bladder and urethra, they’ll make a new way for pee to leave your body. They may create a new bladder using a piece of your intestine. Or they may connect your kidneys and the tubes that carry pee to a small hole in your abdominal wall. This is called a urostomy. The pee will collect in a bag, or sometimes, you can insert a catheter into the hole to drain the bag.

If you had your colon, rectum and anus removed, your surgeon will create a new way for you to poop. They may attach the remaining part of your intestine to your abdominal wall and create an opening (colostomy). You’ll attach a bag to this new opening to collect and dispose of poop.

You may choose to have surgery to reconstruct your vagina (vaginoplasty) if your surgeon removed it as part of your treatment. It depends on whether you’d like to keep the option of having penetrative sex.

How long does a pelvic exenteration take?

The entire procedure usually takes around 12 hours. It’s a long and involved surgery.

Pelvic exenteration recovery

Recovery begins in the hospital. You’ll need to stay there for several days or even weeks before you’re cleared to go home. It may take six months to a year to fully recover. Your care team will help you every step of the way.

They’ll advise you on:

• Managing pain: You’ll get pain medicine in the hospital. You’ll get a prescription for pain medicines to take home with you.
• Caring for your stoma and incisions: Your care team will teach you how to care for your stomas before you leave the hospital. They’ll explain how to check for issues, like infection.
• Getting enough rest: You’ll need to rest for several weeks after surgery. Someone you trust will need to help you bathe and get dressed until you feel better.
• Moving around: It’s important to move regularly. This helps prevent issues like blood clots and constipation.
• Avoiding sitting: Depending on the procedure, you may not be able to sit for up to eight weeks. You’ll be able to stand and lie on your back or side until it’s comfortable to sit.
• Sitting upright: For months or even years after surgery, it may be challenging to sit up straight. This is because your surgeon removed organs that provided structure to your abdomen. Working with a physical therapist to strengthen your stomach muscles can help.

Your healthcare provider will let you know when you can return to your routine.

During recovery, you may benefit from counseling and support groups that connect you with others who’ve had this surgery. For most people, quality of life improves after pelvic exenteration. But getting there takes time. Talking to someone else who’s been where you are can provide a helpful perspective.

When should I call my healthcare provider?

Following surgery, you’ll have regular checkups with your healthcare provider. Call them right away if you have signs of a complication, like:

• Bleeding or swelling in your abdominal area
• Fever, redness and swelling near the incision
• Severe abdominal pain
• Constipation or problems with the ostomies
• Nausea and vomiting

Your healthcare provider will tell you what signs to look out for. Make sure that you understand when to call your provider and when to dial 911 or your local emergency number.

What is life expectancy after pelvic exenteration?

Pelvic exenteration cures cancer in up to 63% of people who get this procedure. This means that more than 6 in 10 people who get this surgery no longer have cancer. The five-year survival rate is about 50% for rectal cancer. It ranges from 30% to 70% for all types of gynecological cancers.

It’s important to remember that these numbers reflect a careful vetting process. Healthcare providers don’t suggest this surgery unless you’re a good candidate. This means that there’s a good chance you can be cured and that you’re healthy enough to manage a tough recovery.

If you’re a candidate, choose a high-volume medical center for this procedure. These surgeries are rare. It’s best to go to a surgery center with doctors who do many of them each year. It can make all the difference in terms of your results.