Pelvic Exenteration for Advanced Pelvic Malignancies

Excerpt

For many patients with bulky, locally advanced primary or recurrent pelvic malignancy, aggressive surgical extirpation is the best treatment option. To remove large pelvic tumors that invade adjacent organs without compromising curability, an en-bloc excision of the tumor and adjacent organs is often required. Total pelvic exenteration—the removal of all pelvic organs, including the rectum, bladder, and reproductive organs—has traditionally been associated with a high rate of complications and few long-term survivors.1‐7 However, since 1948, when Brunschwig8 reported the first series of pelvic exenterations for advanced pelvic malignancies, the practice of pelvic exenteration in the treatment of advanced gastrointestinal, gynecological, and urinary malignancies has significantly evolved. Originally intended as a palliative procedure, pelvic exenteration for advanced pelvic malignancy today is associated with a 5-year survival rate of 20% to 60%.1,3,4,9‐12 With the advent of more refined surgical techniques and improved perioperative care, the mortality and morbidity associated with pelvic exenteration have markedly decreased. As such, when indicated, pelvic exenteration for locally advanced pelvic malignancies should be considered a standard practice in major surgical centers. The purpose of this review is to discuss the role of pelvic exenteration in the management of advanced pelvic malignancies. Herein we provide an overview of the indications for pelvic exenteration, surgical technique, advances in reconstruction, and the morbidity and mortality of pelvic exenteration. …