What is pelvic exenteration surgery?

Pelvic exenteration surgery, also known as a pelvic clearance, is an operation to remove the internal reproductive organs from the pelvic region. These may include:

• The womb
• The ovaries
• The cervix
• The vagina

Depending on the type of exenteration surgery, a doctor may also decide to remove the bladder, the rectum and the lower bowel.

Why is it done?

The operation is done to treat certain cancers, including:

• womb cancer
• vaginal cancer
• cervical cancer
• vulval cancer
• anal cancer
• rectal cancer

Although it is most often used to treat cervical cancer, it may be used when these cancers have spread or returned following previous cancer treatment.

Preparation

As pelvic exenteration is considered major surgery, it is important to discuss the risks, complications and benefits with your doctor prior to the operation.

After deciding to go through with it, you will likely go to a cancer specialist centre to meet the team that will care for you.

During the operation

Exenteration surgery usually takes between 8-12 hours to complete. You will be sedated with general anaesthesia during the entire operation.

There will typically be two or more surgeons from different specialities working together to perform this treatment. They may include a urologist, a colorectal surgeon and a plastic surgeon.

The incision is made down the lower abdomen and your organs are examined to check if the cancer has spread. If it has spread to parts of the body that cannot be removed, the operation will be terminated. If not, it will carry on as planned.

The surgeons will begin removing the affected organs. If your bladDer needs to be removed, it means you will need to wear a stoma bag when you wake up. If your vagina is removed, you may wish to also undergo vaginal reconstructive surgery during which a new vagina is made.

Aftercare & recovery

You will spend a few days in intensive care and then spend up to 3 weeks in the hospital. After you wake up, you can expect your wounds to be dressed.

You may need to use a stoma bag which your nurse will help you with and a physiotherapist will help you get moving around while you recover. Every day at the hospital, you will be encouraged to move around and you might see an occupational therapist to check if you are able to adapt to normal life.

When you leave the hospital, your doctor and hospital staff will provide you with all the necessary information to manage yourself and your recovery at home. It takes several months to fully recover from this type of operation. During the recovery period, you will need extra support to help you move around and get back to normal day-to-day activities.

Risks and complications

There are risks associated with any type of surgical procedure, these include bleeding during or after the operation, blood clots, problems with the general anaesthetic and infections.

Other more specific complications might occur, but it is important to remember that it is rare:

• The joining from the ureters could come apart
• A fistula can occur in the pelvis or abdomen
• The bowel could obstruct
• You kidneys could fail
• Urethral blockages might occur

Adapting to the changes

Women that undergo this operation will experience big changes in their lives and will take time to adjust to them. Hormonal changes in the body and coming to terms with the surgery may make you feel low or depressed. There will be various support groups and specialists set up to help you with this. For example:

• you will have to learn to use a stoma bag: If you have had your bowel removed, you will need to wear a stoma bag to collect faeces. It may be permanent, however, it can sometimes be reversed. There will be a support team set up to help you with this.
• you may have to learn to wear a continent pouch: if you have had your bladder removed, then a pouch will need to be worn to collect urine.
• your sex life will change: The physical changes to your body may mean that there are changes in sensation and you may not like having sex for a while. If your vagina has been removed, you may find it hard to have sex. If it has been reconstructed, you will also need to learn to adapt to your new vagina.
• your body will change: your appearance may alter, with the additional scar and stoma bag attached, you may feel self-conscious for a while.
• there will be emotional and psychological changes: coming to terms with so many changes can be difficult. Support services will be arranged to help you.
• you may not have a vagina: the majority of women have their vagina removed, however, the clitoris usually remains. That means you will still be able to have pleasure and orgasms in this area.
• fertility changes: as the surgeon has removed your reproductive organs, you will not be able to get pregnant. If you have not yet been through menopause, it will begin after the operation. Some women decide to freeze their eggs before surgery and use a surrogate in the future.