Pelvic Exenteration

Procedure

Pelvic exenteration is a surgery performed at RPA for patients with extensive primary or locally recurrent pelvic malignancy, most frequently associated with rectal or gynaecological cancer. A pelvic exenteration is performed to remove cancer that has involved part, or all of, the contents of the pelvis. Surgery can differ from patient to patient depending on the position and involvement of the disease.

Total Pelvic Exenteration:
A Total Pelvic Exenteration removes the bladder, urethra, reproductive organs, rectum, anus, and supporting muscles and ligaments. If bone is involved, a sacrectomy (taking part of sacrum) will also be performed. A Vertical Rectus Abdominis Myocutaneous (VRAM) flap is sometimes used to fill in the cavity of the perineum. This is done by taking a part of the rectus muscle and transposing it, to allow the skin island to exit the area of the anorectal resection. The flap is then tailored to fill in the perineal deficit and stitched to the surrounding skin. A total pelvic exenteration can leave you with two permanent stomas, a colostomy and a urostomy.

Anterior Exenteration:
An Anterior Exenteration removes part or all of the organs towards the front of the pelvic cavity. In females this includes the vagina, uterus, ovaries, bladder and urethra. In males this includes the prostate, bladder and urethra. Usually the rectum and anus are spared. The operation can leave you with a permanent urostomy.

Posterior Exenteration:
A Posterior Exenteration removes part or all of the organs located towards the back of the pelvic cavity. In females this includes the vagina, uterus, ovaries, rectum and anus. In males this includes the rectum and anus. Usually the bladder and urethra can be spared. This operation can leave you with a permanent colostomy.

Lateral Exenteration (left or right)
A Lateral Exenteration removes structures that are involved along the side wall of the pelvis - this can include the ilium and ischium bones as well as important vessels, muscles and nerves. Sometimes vascular teams assist with reconstruction of veins and vessels that are involved during surgery.

Central Exenteration
A Central Exenteration removes part of or all of the organs situated in the middle of the pelvic cavity. This can include bowel, bladder, connective tissue, gynaecological organs and pelvic floor.

Indications:

• Locally advanced rectal cancer
• Recurrent rectal cancer
• Soft tissue tumours
• Squamous cell carcinoma
• Gynaecological cancers

** The indications and surgical management for each patient may differ. Please consult your surgeon for more information or any questions you may have.

Clinical Staff

All patients are managed by a team of clinical staff including;

For more information about the roles of the above staff please read the Pelvic Exenteration Patient Information booklet

Research

Royal Prince Alfred Hospital has a strong history of research in Pelvic Exenteration (PE) surgery. Since the first procedure in 1994 the team, led by Professor Michael Solomon has established a comprehensive database to collect data on all PE patients.

The program currently has a variety of studies running including the two major studies;

• Quality of Life In patient Following Pelvic Exenteration Surgery
• Quality of Life Outcomes After Pelvic Exenteration Surgery

All patients are put into a clinical database called the Pelvic Exenteration Quality Improvement (PESQI) Data Base which is used to run smaller research studies. Currently the unit is running over 30 sub studies in PE surgery.

The evolution of Pelvic Exenteration surgery at RPA can be viewed here

Pelvic Exenteration Patient Information

For more information about Pelvic Exenteration Surgery at RPA please view our Pelvic Exenteration Surgery Patient Information Booklet here

Latest News

Congratulations to the RPA Pelvic Exenteration team, as RPA becomes the first hospital in the world to perform 1000 cases of Pelvic Exenteration surgery.

Commencing in 1994, under the leadership of Professor Michael Solomon, this complex procedure is performed to remove cancer that has involved part, or all of, the contents of the pelvis, giving patients a chance for a better quality of life.

In most cases, Pelvic Exenteration surgery may be a patient's only hope for a cure. Our highly-skilled multi disciplinary team - made up of surgeons, anaesthetists, physicians, nurses, allied health professionals and pain management specialists - care for patients undergoing the surgery.

Reaching the 1000th case milestone is a significant achievement, and it is by far the largest number of cases performed by a single institution worldwide.