Indications, techniques and outcomes for pelvic exenteration in gynecological malignancy

To review recently published literature presenting an overview of the current insights and (clinical and technical) developments on pelvic exenterative surgery for gynecological malignancies.

Lateral recurrences, positive pelvic node status, age and high body mass index should be abandoned as contraindications for pelvic exenteration. F-fluorodeoxyglucose positron emission tomography-computed tomography is a valuable imaging tool, especially for the detection of enlarged lymph nodes and for distinguishing fibrosis from recurrence. Combined omental plus vertical rectus abdominis myocutaenous flaps give significant reduction in complications, whereas fascia sparing (myo)cutaneous flaps seem promising in decreasing donor-site complications.

Pelvic exenteration is indicated when curative alternatives are inferior or exhausted for advanced primary or locally gynecological recurrent cancer confined to the pelvis. Palliative pelvic exenteration should only be considered when disease-related morbidity is uncontrollable with other therapeutic modalities. Modifications in different surgical steps are still evolving to decrease the pelvic exenteration associated high morbidity. A complete resection and lymph node invasion free status are directly related to a better prognosis.