Let's talk about Pelvic Exenteration, one of the biggest surgeries for cancer, in simple terms

We know how difficult it is to fight cancer. Words cannot describe the pain you feel when the cancer comes back after all the treatments and surgeries. In such a situation, your doctor may be talking to you about a major surgery called "Pelvic Exenteration." It's normal to feel scared and shocked when you hear this name. But don't worry. Today, we'll talk clearly and simply about what this really means, why it's being done, and what you'll have to face after it.

Simply put, what is Pelvic Exenteration?

Pelvic exenteration is a very large and complex surgery to treat cancer inside your pelvis. It is usually done as a last resort when all other treatments (such as chemotherapy and radiation therapy) have failed to control the cancer or when the cancer has come back.

This surgery mainly involves removing the reproductive organs where the cancer has spread. Most often, this surgery is performed on women. However, in some cases, men also have to undergo this surgery.

This involves removing organs such as your vagina, uterus, and cervix. Depending on how far the cancer has spread, parts of your urinary tract and digestive tract, such as your bladder and bowel, may also need to be removed.

What are the main types of this surgery?

Pelvic exenteration surgery for women can be divided into three main types: Anterior, Posterior, and Total. Your doctor will determine the type of surgery that is best for you based on the location and extent of your cancer.

No matter what type of surgery you have, your reproductive organs will be removed. You can get a clear idea of ​​this from the table below.

What if this surgery is performed on men?

If a man has this surgery for recurrent pelvic cancer (such as urethral cancer), surgeons remove the bladder, rectum, anus, and part of the colon. In addition, parts of the reproductive system, such as the prostate gland and seminal vesicles, may also be removed.

Why is such a major surgery recommended?

Because this is a very major surgery, doctors only recommend it as a last resort. The main reasons are:

• When other treatments (radiation, chemotherapy) cannot cure the cancer.
• Even if a cancerous tumor is removed through surgery, the cancer may return to the same area or spread to nearby organs.

This surgery is often performed for gynecological cancers. For example:

• Vaginal cancer
• Uterine cancer
• Cervical cancer
• Vulvar cancer

What happens before the surgery?

Before a major surgery like this, you will be examined thoroughly. Your doctor will likely order tests like an MRI scan or CT scan to get clear images of your pelvic organs. These images will help them plan the surgery.

In addition, it also tells you to do things like:

• Some medications, especially blood thinners, may need to be stopped a few days before surgery.
• They tell you not to eat or drink anything the night before the surgery.
• Your doctor will give you clear instructions about all of this.

What happens during the surgery?

Before the surgery begins, you will be given a general anesthetic (a drug given intravenously into your arm). This means that you will be asleep throughout the surgery, so you will not feel any pain.

The details of the surgery will vary depending on the type of surgery you have. The surgeon will make several incisions in your abdomen and carefully remove the cancerous reproductive organs and, if necessary, other organs. Sometimes, a minimally-invasive procedure may be performed.

A new way to release urine and feces

This is the biggest difference in this surgery.

• If your bladder is removed: You will need to create a new way for urine to leave your body. Sometimes a part of your own intestine is taken and used to create something like a new bladder. Or, the tubes that lead from your kidneys are connected to a small opening in the skin of your abdomen. This is called a urostomy . Urine is collected in a bag that is connected to this opening.
• If part of the intestine and anus (Colon/Rectum/Anus) is removed: A new way for stool to exit is created in the same way. The remaining part of the intestine is connected to a hole made in the skin of the abdomen. This is called a colostomy . A bag connected to this collects stool.

This entire surgery can usually take about 12 hours .

What happens after the surgery?

After surgery, you will have to stay in the hospital for a long time. Some people have to stay in the hospital for several weeks. During this time, doctors and nurses will closely monitor your health and give you medication to control the pain.

Some women choose to have a vaginal reconstruction ( vaginoplasty ) after this surgery. If you are interested in this, you can talk to your doctor about it.

After you go home, the hospital will give you detailed instructions on how to care for your surgical incisions and how to keep them clean if you have a colostomy or urostomy. It is very important to follow the instructions carefully to avoid any complications.

What are the benefits and risks of this surgery?

However, like all major surgeries, there are some risks. These include:

• Bowel obstruction, which means food is not moving properly.
• Infection.
• Problems with new openings (ostomies) created to allow urine and stool to exit.
• Spread of an infection to the bloodstream ( Sepsis ).
• Severe bleeding or blood clots.
• Surgical wounds become swollen, red, or reopen.
• Vaginal fistula is a hole between the vagina and other internal organs (e.g., the bladder).
• Although very rare, there is a risk of death after this surgery. Your doctor will discuss this openly with you.

How long does it take to heal?

This is the hardest part. The recovery period is long and challenging.

• You will need to rest completely for several weeks after the surgery. It is not recommended to engage in any physical activity.
• Until you feel a little better, you will definitely need help from a family member with things like bathing, dressing, and walking.
• Depending on the type of surgery you had, you may not be able to sit for about 8 weeks. You may be able to stand and bend over, but it will be difficult to stand for long periods of time.
• Some people find it difficult to sit up straight for months, even years, after surgery. This is because a large amount of the organs and tissue that provided structural support to your abdomen and pelvis have been removed.
• Ask your doctor about exercises and physical therapy you can do to strengthen your abdominal and back muscles.
• It is also very important to stay mentally strong during this time. Counseling and talking to support groups with people who have gone through this surgery like you will be a great source of strength.

In what situations do you need to see a doctor immediately?

After surgery, you will need to see your doctor regularly for checkups. However, if you experience any of the symptoms below, call your doctor immediately.

• Bleeding or excessive swelling from the abdominal area.
• Fever, redness and swelling around the surgical wound (these are signs of infection).
• Unbearable stomach pain.
• Difficulty or inability to control urination or defecation.
• Nausea and vomiting.
• Constipation.

Pelvic Exenteration is a life-changing surgery. But it can be a life-saving and life-saving option. Before making this decision, it is important to discuss all your concerns with your doctor and get a clear and realistic understanding.