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Pelvic Exenteration is major surgical treatment commonly performed in cases of advanced or recurrent cervical cancer, vulvar cancer and vaginal cancer. This is a surgery that is performed when more conventional surgical methods are not capable of removing the extent of the tumor or are not technically possible. The procedure involved in Pelvic Exenteration leaves patients with a permanent colostomy, whereby the colonic contents are expelled into a bag, which fastens on the abdomen, on the left side. The bladder is reconstructed from bowel to supply a reservoir that drains into a pouch in the abdomen. During Pelvic Exenteration the urinary bladder, vagina, cervix, urethra, uterus, rectum, anus are removed.
Brunschwig was the first to report a case of Pelvic Exenteration in the year 1948 where he described it as a particularly radical surgical treatment for recurring cervical cancer. Pelvic Exenteration is the only remedial option for some patients with centrally recurrent cervical and vaginal cancers. Since the time of Brunschwig, development in antibiotics, thromboembolism prophylaxis and hyperalimentation have enhanced the mortality and morbidity rates related with Pelvic Exenteration. These developments were also accompanied by related advances in surgical technique, which involve the use of separate urinary conduits, stapling devices and pelvic reconstruction.
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After diagnosing the symptoms of recurrent cervical cancer, Pelvic Exenteration is considered. Patients suffering from with recurrent cervical cancer following radiation therapy generally present with hematuria, bleeding or pelvic pain. In a few instances, the first indication of recurrence is the detection of hydronephrosis or abnormal cytology on regular follow-up. It is essential to first confirm a recurrence with a pathologic specimen acquired by biopsy prior to proceeding with the surgical procedure. There are several lab studies and imaging studies conducted before resorting to pelvic surgery. The laboratory evaluation includes CBC count; coagulation studies, comprehensive metabolic panel, type and cross match for blood products.
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The imaging studies done prior to conducting Pelvic Exenteration include Chest radiograph or CT scan, CT scans of abdomen and pelvis, MRI, Liver ultrasonography and Bone scan to assess for metastatic disease. Using imaging studies in assessing a patient for pelvic Exenteration is based on the initial evaluation of tumor size and location. The majority of the patients require a CT scan of the pelvis and abdomen as well as a chest radiograph. The other imaging studies include Positron emission tomography (PET) scanning. There are other tests done such as psychological assessment and assessment of comorbid conditions.
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