Recent advances in surgical reconstruction of the gynecologic cancer patient

Despite significant advances in radiation oncology and chemotherapy, radical en bloc resection of pelvic tissue remains an important part of the armamentarium of the gynecologic oncologist. Total pelvic exenteration can be the only hope of women who failed more conservative therapy. The time has come where it is appropriate to employ temporary techniques in the discipline of reconstructive surgery to restore these women to an acceptable quality of life. It may be the next challenge for the pelvic surgeon to participate in such surgical reconstruction. This challenge is becoming an active part of the oncologic surgical practice in head and neck surgery, and in breast surgery. Reconstructive surgery of the vulva has been well described in the literature with the use of cutaneous and myocutaneous flaps, and it is beyond the scope of this paper to recount them here. This paper reviews the techniques that are available for reconstruction of a functional vagina, restoration of a functional rectum with elimination of colostomy, and reconstruction of a continent urostomy that will allow better physiologic protection of the upper renal tracts and improve the aesthetics of a urine ostomy bag.