Pelvic exenteration (or pelvic evisceration) is a radical

surgical Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

treatment that removes all organs from a person's

pelvic cavity The pelvic cavity is a body cavity that is bounded by the bones of the pelvis. Its oblique roof is the pelvic inlet (the superior opening of the pelvis). Its lower boundary is the pelvic floor. The pelvic cavity primarily contains the reproduc ...

. It is used to treat certain advanced or recurrent

cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...

s. The

urinary bladder The urinary bladder, or simply bladder, is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans the bladder is a distensible organ that sits on the pelvic floor. Urine ente ...

urethra The urethra (from Greek οὐρήθρα – ''ourḗthrā'') is a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body of both females and males. In human females and other primates, the urethra c ...

, rectum, and anus are removed. In women, the

vagina In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...

, cervix,

uterus The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The ...

, Fallopian tubes,

ovaries The ovary is an organ in the female reproductive system that produces an ovum. When released, this travels down the fallopian tube into the uterus, where it may become fertilized by a sperm. There is an ovary () found on each side of the body. T ...

and, in some cases, the

vulva The vulva (plural: vulvas or vulvae; derived from Latin for wrapper or covering) consists of the external female sex organs. The vulva includes the mons pubis (or mons veneris), labia majora, labia minora, clitoris, vestibular bulbs, vulv ...

are removed. In men, the

prostate The prostate is both an accessory gland of the male reproductive system and a muscle-driven mechanical switch between urination and ejaculation. It is found only in some mammals. It differs between species anatomically, chemically, and phys ...

is removed. The procedure leaves the person with a permanent

colostomy A colostomy is an opening (stoma) in the large intestine (colon), or the surgical procedure that creates one. The opening is formed by drawing the healthy end of the colon through an incision in the anterior abdominal wall and suturing it into ...

and

urinary diversion Urinary diversion is any one of several surgical procedures to reroute urine flow from its normal pathway. It may be necessary for diseased or defective ureters, bladder or urethra, either temporarily or permanently. Some diversions result in a ...

. Pelvic exenteration often leads to complications, such as

infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dis ...

kidney damage Kidney disease, or renal disease, technically referred to as nephropathy, is damage to or disease of a kidney. Nephritis is an inflammatory kidney disease and has several types according to the location of the inflammation. Inflammation can b ...

embolism An embolism is the lodging of an embolus, a blockage-causing piece of material, inside a blood vessel. The embolus may be a blood clot (thrombus), a fat globule (fat embolism), a bubble of air or other gas ( gas embolism), amniotic fluid (am ...

perineal hernia Perineal hernia is a hernia involving the perineum ( pelvic floor). The hernia may contain fluid, fat, any part of the intestine, the rectum, or the bladder. It is known to occur in humans, dogs, and other mammals, and often appears as a sudden ...

, and problems with the stomas created. However, it increases 5-year survival rate from certain cancers. The procedure was first described by Alexander Brunschwig in 1948.

Uses

Pelvic exenteration is an option in cases of very advanced or recurrent

, for which less radical surgical options are not technically possible or would not be sufficient to remove all the tumor. This procedure is performed for several types of cancer including genitourinary cancer, and colorectal cancers. It is rarely performed due to common complications.

Contraindications

Pelvic exenteration may not cure certain

s. This can happen if there are

metastases Metastasis is a pathogenic agent's spread from an initial or primary site to a different or secondary site within the host's body; the term is typically used when referring to metastasis by a cancerous tumor. The newly pathological sites, then ...

in the

liver The liver is a major organ only found in vertebrates which performs many essential biological functions such as detoxification of the organism, and the synthesis of proteins and biochemicals necessary for digestion and growth. In humans, it ...

, the sidewall of the

, the aortic lymph nodes, or through carcinosis. In these cases, it may not be used. It may also not be used when both ureters are obstructed.

Complications

Between 60% and 90% of all people who have a pelvic exenteration have a complication. The large surgical incision may become infected.

Fever Fever, also referred to as pyrexia, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using val ...

and

sepsis Sepsis, formerly known as septicemia (septicaemia in British English) or blood poisoning, is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage is follo ...

may occur. The

kidney The kidneys are two reddish-brown bean-shaped organs found in vertebrates. They are located on the left and right in the retroperitoneal space, and in adult humans are about in length. They receive blood from the paired renal arteries; blo ...

s may be damaged, usually due to reduced blood flow and

ischaemia Ischemia American and British English spelling differences#ae and oe, or ischaemia is a restriction in blood supply to any tissue (biology), tissue, Skeletal muscle, muscle group, or Organ (biology), organ of the body, causing a shortage of oxyg ...

Embolism An embolism is the lodging of an embolus, a blockage-causing piece of material, inside a blood vessel. The embolus may be a blood clot (thrombus), a fat globule (fat embolism), a bubble of air or other gas ( gas embolism), amniotic fluid (am ...

s may occur. After pelvic exenteration, many patients will have

, often without symptoms, but only 3–10% will have perineal hernia requiring surgical repair. Many problems can occur with the stoma. Bowel obstruction may occur, or the anastomosis created by the surgery may leak. The stoma may retract, or may prolapse. Rarely, it may necrose.

Technique

Pelvic exenteration involves removal of all of the pelvic organs. These include the

, rectum, and anus. In women, the

, cervix,

, fallopian tubes,

and, in some cases, the

are removed. In men, the

is removed. Patients receive significant counselling before the procedure so that they fully understand the benefits and risks.

Radiology Radiology ( ) is the medical discipline that uses medical imaging to diagnose diseases and guide their treatment, within the bodies of humans and other animals. It began with radiography (which is why its name has a root referring to radiat ...

is used before surgery. The surgery itself is complex.

Recovery

Pelvic exenteration leaves a person with a permanent

and

. A 2015 article reports that pelvic exenteration can provide long-term survival for patients with locally advanced primary rectal carcinoma. The 5-year survival rate of patients undergoing pelvic exenteration following complete resection of disease was 59.3%. Factors shown to influence the survival rate following a pelvic exenteration procedure include age, the presence of metastatic disease, lymph node status, circumferential

resection margin A resection margin or surgical margin is the margin of apparently non-tumorous tissue around a tumor that has been surgically removed, called " resected", in surgical oncology. The resection is an attempt to remove a cancer tumor so that no por ...

, local recurrence of disease, and the need for

neoadjuvant therapy Neoadjuvant therapy is the administration of therapeutic agents before a main treatment. One example is neoadjuvant hormone therapy prior to radical radiotherapy for adenocarcinoma of the prostate. Neoadjuvant therapy aims to reduce the size or ...

History

The procedure was first described by Alexander Brunschwig in 1948.Brunschwig A: Complete excision of the pelvic viscera for advanced carcinoma. Cancer 1948; 1: 177.

References

{{DEFAULTSORT:Pelvic Exenteration Surgical oncology Female genital procedures