Pelvic exenteration and its modifications

Since it was first reported in 1948, pelvic exenteration has been used in the treatment of advanced pelvic cancers. The original procedure has been modified in an attempt to preserve urinary or fecal continence. A literature review was performed on selected series of total pelvic exenterations and modified pelvic exenterations in order to assess and discuss the different types of pelvic exenterations and the indications, contraindications, morbidity, mortality, and results of these procedures. According to the series reviewed, morbidity after pelvic exenteration ranges between 32% and 84%, postoperative mortality ranges from 0% to 14%, and 5-year survival varies from 23% to 68%. These numbers indicate that total pelvic exenteration and its modifications are a complex group of surgical procedures with significant early and late postoperative morbidity and mortality. While the authors do feel that these findings indicate that pelvic exenteration should only be undertaken by experienced surgeons at specialized centers, the authors caution that, above all, their findings indicate that the potential curability of a patient with adjacent organ involvement should not be compromised by doing less than an en bloc resection