Pelvic exenteration

Pelvic exenteration
Intervention
ICD-9-CM 68.8
MeSH D010385

Pelvic exenteration (or pelvic evisceration) is a radical surgical treatment that removes all organs from a person's pelvic cavity. The urinary bladder, urethra, rectum, and anus are removed.

The procedure leaves the person with a permanent colostomy and vesicostomy. In women, the vagina, cervix, uterus, fallopian tubes, ovaries, and in some cases the vulva are removed. In men, the prostate is removed.

The operation is controversial, because it has not been subject to controlled clinical trials. Barron H. Lerner said that was the extreme case of procedures that provided "little or no benefit, while causing dying cancer patients disfigurement and suffering."[1]

Contents

Indications

Pelvic exenteration is most commonly used in cases of very advanced or recurrent cancer, in which less radical surgical options are not technically possible or would not be sufficient to remove all the tumor. This procedure is performed for many types of cancer including genitourinary and colorectal cancers.

Complications

After pelvic exenteration, many patients will have perineal hernia, often without symptoms, but only 3–10% will have perineal hernia requiring surgical repair.[2]

History

The procedure was first described by Alexander Brunschwig in 1948.[3][4]

References

  1. ^ The Annals of Extreme Surgery By BARRON H. LERNER, New York Times, August 29, 2011
  2. ^ Berman L, Aversa J, Abir F, Longo WE (July 2005). "Management of disorders of the posterior pelvic floor". Yale J Biol Med 78 (4): 211–21. PMC 2259151. PMID 16720016. http://openurl.ingenta.com/content/nlm?genre=article&issn=0044-0086&volume=78&issue=4&spage=211&aulast=Berman. 
  3. ^ Brunschwig A: Complete excision of the pelvic viscera for advanced carcinoma. Cancer 1948; 1: 177.
  4. ^ med/3332 at eMedicine