%0 Journal Article
%T Total Pelvic Exenteration for Gynecologic Malignancies
%A Elisabeth J. Diver
%A J. Alejandro Rauh-Hain
%A Marcela G. del Carmen
%J International Journal of Surgical Oncology
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/693535
%X Total pelvic exenteration (PE) is a radical operation, involving en bloc resection of pelvic organs, including reproductive structures, bladder, and rectosigmoid. In gynecologic oncology, it is most commonly indicated for the treatment of advanced primary or locally recurrent cancer. Careful patient selection and counseling are of paramount importance when considering someone for PE. Part of the evaluation process includes comprehensive assessment to exclude unresectable or metastatic disease. PE can be curative for carefully selected patients with gynecologic cancers. Major complications can be seen in as many as 50% of patients undergoing PE, underscoring the need to carefully discuss risks and benefits of this procedure with patients considering exenterative surgery. 1. Introduction Pelvic exenteration (PE) describes a radical surgery involving the en bloc resection of the pelvic organs, including the internal reproductive organs, bladder, and rectosigmoid. Indications include advanced primary or recurrent pelvic malignancies, most commonly centrally recurrent cervical carcinoma, but also other gynecologic tumors and urologic and rectal cancers. Distant metastasis has traditionally been a contraindication to PE with curative intent. As the best chance for disease-free survival is surgical resection of regional disease, this procedure is an opportunity to cure advanced and recurrent cancers confined to the pelvis. PE has also been used for palliation of symptoms related to radiation necrosis or extensive tumor burden. Both total and partial PE require extensive reconstruction and surgical recovery with significant associated morbidity and mortality. Careful patient selection is required to balance the potential goal of cure or symptom palliation with surgical risk. The first cases of total PE were described by Brunschwig in 1948 as a palliative procedure for symptoms caused by locally advanced gynecologic cancers. This demonstrated proof of concept for PE, with a postoperative survival of up to 8 months, and a 23% surgical mortality rate [1]. Subsequent data demonstrated that the technique could offer a chance of cure for centrally located tumors, not just palliation, and the focus of the surgery shifted to one of curative intent. Various surgical approaches both for sparing uninvolved pelvic organs and removing extraperitoneal structures such as the sacrum were attempted. Major breakthroughs included separate stomata for urine and fecal diversion and the use of omentum to protect the empty and denuded pelvic space and reduce abscess formation and
%U http://www.hindawi.com/journals/ijso/2012/693535/