Pelvic exenteration

A survey of the literature over a 30-year period suggests that exenteration operations have not been widely accepted or perhaps not commonly reported except in the United States. Even in the United States, the series reported are usually of very small numbers. The reasons for this are difficult to explain except to say that the most widely indicated factor is carcinoma of the cervix and this has been decreasing in incidence as far as the more advanced stages are concerned. It is being detected at an earlier stage with a greater chance for cure without recurrence. Endometrial and ovarian cancer have been on the increase, with endometrial cancer being diagnosed early with excellent results and ovarian cancer occurring in an advanced stage with a presentation that does not lend itself readily to radical pelvic surgery. It must be stated that in cases where pelvic exenteration is indicated, and these are highly selective ones, there is no other equally curative form of therapy that exists for the distressing problem of recurrent pelvic cancer. With the new stapling techniques and the use of clips along the pelvic wall to control bleeding from the blood vessels in this area, it is possible to perform a pelvic exenteration with much less blood loss and in considerably less time than previously. The improved methods of monitoring these patients with a Swan-Ganz catheter and a better understanding of the metabolic and physiologic process has reduced the mortality rate to less the 5%. Having given these patients a quantity of life, it is important to give them a quality of life. These patients should be rehabilitated and, if needed, a vagina should be reconstructed and the patient encouraged to lead a normal life. Perhaps these patients cannot be described as happy, but at least given a second chance for life they can become well adjusted and make significant contributions to their family and the community.