What is Pelvic Exenteration?
Pelvic exenteration is a surgical procedure that involves the removal of the bladder and/or part of the lower bowel along with internal reproductive organs to treat advanced or recurrent cancers. The 3 different types of pelvic exenteration include:
- Anterior pelvic exenteration: This type of exenteration is used when there is cancer of the reproductive organs and urinary bladder present in the anterior of the pelvis. The bladder is removed with the reproductive organs and a new opening for urine is created called a urostomy.
- Posterior pelvic exenteration: This surgery is used when there is cancer at the back or posterior area of the pelvis. The lower bowel and reproductive organs are removed and a colostomy is created for bowel movements.
- Total pelvic exenteration: This surgery includes complete removal of the pelvis i.e. the reproductive organs, bladder and the whole of the lower bowel.
Procedure for Pelvic Exenteration
Pelvic exenteration is a 2-stage procedure performed under general anaesthesia. The first stage involves the resection of the organs. Your doctor makes an incision from your lower abdomen to the pelvis. A thorough examination of the pelvic region and surrounding lymph nodes is performed to identify cancerous growth. Tissue samples may also be sent to the laboratory for testing. Based on these test results and extent of damage to the surrounding organs, the bladder and/or bowel are removed along with other reproductive organs, their lymph nodes and other supporting tissues.
The second stage involves the reconstruction and restoration of urinary and bowel function. With the removal of the bladder, your surgeon needs to create a new place for the storage and elimination of urine. Urostomy is performed, where a pouch is created from a section of the intestine and connected to the abdominal wall. Urine can be regularly drained through a catheter (narrow tube). A colostomy may also be necessary if the rectum was removed. Your surgeon attaches the end of the intestine to an opening in the abdominal wall through which the stools can pass into a bag at the front of the abdomen.
Risks Associated with Pelvic Exenteration
As with all surgeries, pelvic exenteration may also involve risks such as infections, bleeding, blood clots in the legs, formation of fistula in the remaining urinary tract, lung infections and fluid accumulation in the lungs.