What is pelvic exenteration?

Pelvic exenteration is an operation (surgery) to remove multiple organs in the pelvis. The internal reproductive organs (the ovaries, womb, cervix and vagina) are removed. Depending on the type of pelvic exenteration the surgeon may also remove:

  • the bladder
  • part of the lower bowel (rectum)
  • both the bladder and the rectum.

The operation is sometimes called pelvic clearance.

Before the operation, you will be referred to a specialist cancer nurse. They will give you information and emotional support.

You have pelvic exenteration in a specialist centre. Only specialist surgeons do the surgery. They are trained and experienced in doing this type of operation.

Pelvic exenteration can cure cancer in some people. But it is a major operation. It is important to discuss the benefits and risks with your surgeon, before deciding (consenting) to have it.

Why pelvic exenteration is done

This operation (surgery) can be done to treat cancers in the pelvis. Pelvic exenteration can be used to treat the following cancers:

It can be used when cancer has spread within the pelvis, or has come back in the pelvis after other treatments. Pelvic exenteration is most often used to treat cervical cancer that has come back after treatment.

Usually, you only have pelvic exenteration if there are no signs of cancer anywhere else in the body. But if you have rectal cancer, you may still have the operation if there is cancer in other parts of the body, such as the lungs or liver. This is only if these areas can be treated after the pelvic exenteration.

Types of pelvic exenteration operation in women

There are different types of pelvic exenteration surgery. The type you have will depend on:

  • the type of cancer you have
  • where the cancer is in the pelvis
  • what treatments you have had before.

The different types are:

  • anterior exenteration
  • posterior exenteration
  • total exenteration.

Your surgeon may not know what type of operation you need until they start the surgery.

Anterior exenteration

This operation involves removing organs in the front part of the pelvis. The surgeon will remove:

  • the bladder
  • the cervix
  • the ovaries
  • part or all of the vagina
  • the womb.

Usually urine (pee) drains from the kidneys, through tubes called ureters, to the bladder. Urine is stored in the bladder until you are ready to pass urine. After the bladder is removed, urine needs to leave the body in a different way. You will have a urinary diversion.

The surgeon makes an opening on the tummy (abdomen) called a stoma. When the bladder is removed, the surgeon connects the end of the ureters to this opening. Depending on the type of urinary diversion you have, you may wear a bag over the stoma to collect urine.

If the vagina was removed, sometimes the surgeon can make a new one. This is called vaginal reconstruction.

The female pelvic organs, showing the areas removed during anterior exenteration
The female pelvic organs, showing the areas removed during anterior exenteration

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Posterior exenteration

This operation involves removing organs in the back part of the pelvis. The surgeon will remove:

  • the cervix
  • the ovaries
  • the womb
  • the lower part of the bowel (the rectum and sometimes the anus).

They may also remove part, or all the vagina. If this is done, sometimes the surgeon can make a new vagina. This is called vaginal reconstruction.

Usually stools (poo) leave the body through the rectum and the anus. After the rectum is removed, stools need to leave the body in a different way. The surgeon makes an opening on the tummy (abdomen) called a stoma. They connect the end of the bowel to this opening. This is called a colostomy. You wear a colostomy bag over the stoma to collect the stools.

The female pelvic organs, showing the areas removed during posterior exenteration
The female pelvic organs, showing the areas removed during posterior exenteration

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Total exenteration

This surgery involves removing all the organs in the pelvis. The surgeon will remove:

  • the ovaries
  • the womb
  • the cervix
  • part or all of the vagina
  • the bladder
  • the lower part of the bowel (the rectum and sometimes the anus).

Usually urine (pee) drains from the kidneys, through tubes called ureters, to the bladder. Urine is stored in the bladder until you are ready to pass urine. After the bladder is removed, urine needs to leave the body in a different way. You will have a urinary diversion.

The surgeon makes an opening on the tummy (abdomen) called a stoma. When the bladder is removed, the surgeon connects the end of the ureters to this opening. Depending on the type of urinary diversion you have, you may wear a bag over the stoma to collect urine.

Usually stools (poo) leave the body through the rectum and the anus. After the rectum is removed, stools need to leave the body in a different way. The surgeon makes an opening on the tummy (abdomen) called a stoma. They connect the end of the bowel to this opening. This is called a colostomy. You wear a colostomy bag over the stoma to collect the stools.

If the vagina was removed, sometimes the surgeon can make a new one. This is called vaginal reconstruction.

The female pelvic organs, showing the areas removed during total pelvic exenteration
The female pelvic organs, showing the areas removed during total pelvic exenteration

View a large version

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Back to Pelvic exenteration in women

Having pelvic exenteration

Pelvic exenteration takes about 8 hours – after the surgery, urine (pee) and stools (poo) will leave your body in a new way.