Pelvic exenteration for carcinoma of the cervix

Pelvic exenteration for carcinoma of the cervix uteri carries a 15 per cent operative mortality and a 23.3 per cent five-year survival. Total exenteration, not anterior exenteration or modified exenteration, is the operation of choice in the heavily irradiated patient. The criteria for operability are proof of persistence of disease, proof of no extension of disease beyond the pelvis, proof of freedom of disease at the lateral margins of resection and proof that pelvic-lymph-node metastases are minimal. Only 2 of 33 patients with positive pelvic lymph nodes survived for five years. Ileal-loop urinary diversion has been a major factor in diminishing the complications and deaths from this procedure.