Pelvic exenteration

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PELVIC exenteration comprises the removal of female structures in the pelvis, together with the rectum and/or the bladder. Total pelvic exenteration consists of the removal of all pelvic organs—rectum, bladder, urethra, uterus, tubes, ovaries, and vagina. The operation is complicated by the fact that both urinary and fecal diversion must be accomplished. Partial exenteration is performed when the bladder is spared (posterior exenteration) or when the rectum is spared (anterior exenteration).

Pelvic exenteration is not only feasible, but is worthwhile treatment for carefully selected women who have advanced cancer that otherwise cannot be cured. Though the rate of postoperative complications is high, nevertheless, a large number of women have been cured and have been able to lead active and rewarding lives.

Pelvic exenteration is not being utilized to the optimal extent, for two closely related reasons. First, because of misconceptions on the part of physicians and patients in regard to the risk of operation and the potential for rehabilitation and physical performance after surgery, exenteration is considered only as a last resort, with the result that the optimal time for performing such surgery has long since passed. Secondly, even when physicians are convinced of the value of such surgery, persistent or recurrent disease is difficult to diagnose at a stage early enough to make possible successful excisional surgery. These conclusions are based on experience at the Cleveland Clinic since 1951. Forty-seven exenterations were performed for various advanced pelvic cancers: total exenteration 31 times, anterior exenteration 14 times, and posterior . . .



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