Pelvic exenterations: supralevator, infralevator, and with vulvectomy

The purpose of this study was to determine whether the different types (I, II, and III) of pelvic exenterations have prognostic implications in regard to operative features, postoperative complications, and survival. The records of the 133 patients who underwent pelvic exenteration at the Mayo Clinic from 1977 to 1986 were reviewed. The records were abstracted for duration of hospitalization, febrile morbidity, duration of operation, operative blood loss, number of blood transfusions, performance of a perineal phase, development of an omental carpet, vaginal reconstruction, reoperation, additional tissue resection, complications, and survival. Statistically significant differences were noted univariately between types I, II, and III in regard to the development of an omental carpet, whether or not vaginal reconstruction was done, the performance of a perineal phase, the resection of additional tissues, and the duration of hospitalization. The operative and postoperative morbidity and survival were not influenced significantly by the type of exenteration. The subclassification of the exenteration groups into type I (supralevator), type II (infralevator), and type III (with vulvectomy) is helpful to facilitate understanding of the extent of resection of the pelvic structures and the anatomical changes associated with each operation. Subgrouping facilitates communication, not only between pelvic surgeons but also with third-party payers.