Pelvic exenteration is a surgical procedure to remove various organs in the pelvic region in case of recurrent cancers. This technique is used to remove the bladder, reproductive organs such as uterus, cervix, vagina, and parts of the gastrointestinal tracts such as rectum, or anus. Pelvic exenteration is major surgery and is done under general anesthesia. It is performed only when cancer has not spread to other parts of the body.
Radical pelvic exenteration
Organs in the pelvic region (e.g. uterus, colon, rectum, reproductive organs)
Pelvic exenteration is performed under sedatives and anesthesia to block the pain and sensation. A few small incisions are made in the abdominal wall. A laparoscope (instrument with a small camera) is inserted through one of the incisions to create images for guiding the surgeon to and examine the pelvic region and abdominal cavity.
A larger cut is made and the affected tissues or organs are removed could include the reproductive organs, bladder, lymph nodes & parts of the rectum. Following the removal of cancerous tissue/organ, reconstruction is done to restore various body functions depending upon the location of the surgery. These could include reconstructing the vagina, urinary diversion, or colostomy (for passing stools).
- Before undergoing pelvic exenteration, it is crucial to prepare and understand the outcomes and expectations. Your surgeon will recommend you to undergo certain blood tests and a pre-anesthesia check-up (PAC) that would also include a chest X-ray, electrocardiogram (ECG) along with a physical examination to assess your suitability for the surgery. You will also undergo imaging tests to assess the spread of cancer and the location of the surgery.
- You should eat light food the day before surgery and fast for at least 6-8 hours before the surgery, to avoid complications during the surgery.
- Inform your doctor about all your medications and you could be asked to discontinue blood-thinning medications. Also, you could be prescribed certain medications to calm your nerves.
- You should reach the hospital 4-6 hours before the surgery as you will be kept under observation for some time.
You should continue with your follow-ups as per the schedule for a complication-free recovery. Usually, your surgeon will give a follow-up chart to follow until your incision wounds have healed. In addition, you should take proper rest as recommended by your doctor and do not overexert yourself. Avoid housework and seek help from your family members or friends. You can start returning to your routine activities in a few weeks. Wear loose clothes and eat nutritious food. Keep your wounds clean and dry. You should check with your doctor regarding the bathing. Look for any signs of infection, swelling, or redness at the incision site. Take your medication as prescribed, and drink plenty of water and oral fluids.
Being a major surgery, there are various risks associated with pelvic exenteration such as:
- Bleeding from the incision site or surrounding organs
- Incision site infections could occur and you might need antibiotic treatment following the surgery.
In addition, surgery could be associated with the following side effects:
- Damage to an adjoining organ
- Vaginal dryness
- Recurrent urinary tract infection
- Bowel changes
- Blood clot formation
- Postoperative pneumonia
- Wound separation
- Fistula formation
- Hypersensitivity reaction to anesthesia
Depending on the site of the surgery, you will be transferred to the recovery room after a few hours to a couple of days. Once your vital signs have stabilized, you will be shifted to the hospital room/ward and within a few days, you will be discharged from the hospital.
The recovery will take a few weeks and you can slowly start returning to your normal activities. While you are in recovery mode, avoid housework for a few weeks that could stress your body. Walking and breathing exercises are imperative for quick recovery and avoiding complications. Getting regular follow-ups done per the schedule is also crucial to achieving a complication-free recovery.
Take good care of the incision wounds and keep them clean. Take your medications including painkillers, and antibiotics as prescribed. If you experience unexplained pain, excessive vomiting, or any other side effects, seek medical attention.