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Exenteration for gynecologic cancer

Authors
Ken D Hatch, MD
William J Mann, Jr, MD
Section Editor
Barbara Goff, MD
Deputy Editor
Sandy J Falk, MD, FACOG

INTRODUCTION

Exenteration refers to an ultraradical surgical procedure consisting of an en bloc resection of the female reproductive organs, lower urinary tract, and a portion of the rectosigmoid. Although rarely performed, it may be offered as a last hope of cure to women with recurrent or advanced gynecologic cancer with extensive central pelvic disease that cannot be resected with a lesser procedure, and in whom radiation is not an option. If the disease is truly confined to the pelvis, then this extended surgical resection offers a chance of cure: five-year survival rates are approximately 50 percent [1,2].

This topic review will discuss the indications and operative technique for exenterative surgery of the female pelvis. The evolution of pelvic exenterative surgery can be found elsewhere [3-13].

TERMINOLOGY

Total exenteration refers to removal of the uterus, tubes, ovaries, parametrium, bladder, rectum or rectal segment, vagina, urethra, and a portion of the levator muscles. In an anterior exenteration, the rectum is spared, while in a posterior exenteration, the bladder and urethra are preserved. A perineal phase, resecting the anus, urethra, and portions of the vulva, may also be required (figure 1).

There is no "standard" exenteration. The choice of procedure is based upon the location of the cancer, difficulties that may arise during surgery, type and location of previous radiotherapy, anatomy, and the patient's postoperative goals and expectations.

INDICATIONS

The potential for cure by exenterative surgery requires that the patient's cancer be resected in its entirety with adequate margins. Thus, diseases that spread by lymphatic, blood, or peritoneal pathways early in their course will rarely lend themselves to ultraradical resection.

                                  

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Literature review current through: Nov 2016. | This topic last updated: Mon Jul 21 00:00:00 GMT+00:00 2014.
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