A pelvic exenteration is the most extreme pelvic surgery you can get, whereby almost all pelvic organs are removed, usually due to a return of cancerous growths after radiation or chemotherapy.
Structures and organs removed in a pelvic exenteration
- Uterus
- Cervix
- Ovaries
- Fallopian tubes
- Vagina
- Bladder (sometimes)
- Urethra (sometimes)
- Rectum (sometimes)
How a pelvic exenteration is performed
An opening will be made for urine, and one for stool, called stomas or ostomies, and the vagina can be rebuilt, called a vaginoplasty.1,2
A pelvic exenteration is a radical surgery and salvage procedure for recurrent gynaecological or rectal/colonic cancers. The cancer may have previously been treated with surgery and/or radiation.3,4
Ovarian cancer is not usually treated with a pelvic exenteration due to the spread that is associated with ovarian cancers. The operation comes with significant risks, though improvements in hospital care have reduced negative outcomes.5
The five-year survival rate of successful surgery is between 20 and 50 per cent.
Recovery from a pelvic exenteration
Pelvic exenteration is a massive surgery, and recovery takes a long time. It can take six months to feel fully healed after this surgery and up to two years to appreciate the changes made to how your body works.6
Quality of life is usually reduced after surgery, but it improves as you adjust to the new you.
Penetrative sex after a pelvic exenteration
Penetrative sex is impossible without a vagina, but with a new vagina (the neovagina created via vaginoplasty), it can be possible to enjoy sex. Neovaginas also have their own type of microbiome.
The clitoral tissue may still remain completely intact, along with the outer genitalia (vulva), and therefore sexual pleasure and orgasm may still be within your grasp.7
One of the issues with this type of surgery is the removal of the clitoral nerve supply, which can cause issues, but with persistence, orgasm and pleasure can be had.
Talk to your doctor
Every surgery is different, so talk to your surgeon before the procedure, discuss your clitoral nerves and see what they can do to help keep these intact.
Recurrent cervical cancer
If cervical cancers recur and other treatments have failed, surgical resection may be one of the only options left for removing the cancer from the body.8
Usually, someone having a pelvic exenteration will have recurrent cervical cancers and have received radiation therapy, with a chance of a cure after the procedure.
Surgery is complex to perform correctly on radiated tissue since it causes changes in the tissue that don’t permit a lot of proper healing to occur and can destroy elasticity. This makes stitching tissue together fraught with difficulties.
Sometimes a pelvic exenteration may be performed as a palliative care option when unmanageable symptoms and fistulas are appearing in the pelvic area due to cancers.9
When a pelvic exenteration will not be performed (contraindications)
Anyone presenting with certain metastasis (peritoneal, bowel, distant) can’t undergo the procedure, however this will be determined on a case-by-case basis by a specialist.10
References
- 1.Kaartinen IS, Vuento MH, Hyöty MK, Kallio J, Kuokkanen HO. Reconstruction of the pelvic floor and the vagina after total pelvic exenteration using the transverse musculocutaneous gracilis flap. Journal of Plastic, Reconstructive & Aesthetic Surgery. Published online January 2015:93-97. doi:10.1016/j.bjps.2014.08.059
- 2.Minimally invasive surgery techniques in pelvic exenteration: a systematic and meta-analysis review. Surg Endosc. Published online July 17, 2018:4707-4715. doi:10.1007/s00464-018-6299-5
- 3.Lampe B, Luengas-Würzinger V, Weitz J, et al. Opportunities and Limitations of Pelvic Exenteration Surgery. Cancers. Published online December 7, 2021:6162. doi:10.3390/cancers13246162
- 4.Pawlik TM, Skibber JM, Rodriguez-Bigas MA. Pelvic Exenteration for Advanced Pelvic Malignancies. Ann Surg Oncol. Published online March 17, 2006:612-623. doi:10.1245/aso.2006.03.082
- 5.Rutledge FN, Smith JP, Wharton JT, O’Quinn AG. Pelvic exenteration: Analysis of 296 patients. American Journal of Obstetrics and Gynecology. Published online December 1977:881-892. doi:10.1016/0002-9378(77)90521-x
- 6.Ng KS, Lee PJM. Pelvic exenteration: Pre-, intra-, and post-operative considerations. Surgical Oncology. Published online June 2021:101546. doi:10.1016/j.suronc.2021.101546
- 7.McCarthy ASE, Solomon MJ, Koh CE, Firouzbakht A, Jackson SA, Steffens D. Quality of life and functional outcomes following pelvic exenteration and sacrectomy. Colorectal Disease. Published online January 5, 2020:521-528. doi:10.1111/codi.14925
- 8.Ubinha ACF, Pedrão PG, Tadini AC, et al. The Role of Pelvic Exenteration in Cervical Cancer: A Review of the Literature. Cancers. Published online February 18, 2024:817. doi:10.3390/cancers16040817
- 9.Lewandowska A, Szubert S, Koper K, Koper A, Cwynar G, Wicherek L. Analysis of long-term outcomes in 44 patients following pelvic exenteration due to cervical cancer. World J Surg Onc. Published online September 2, 2020. doi:10.1186/s12957-020-01997-3
- 10.Lampe B, Luengas-Würzinger V, Weitz J, et al. Opportunities and Limitations of Pelvic Exenteration Surgery. Cancers. Published online December 7, 2021:6162. doi:10.3390/cancers13246162
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