Pelvic Exenteration: Let's talk about this major surgery for cancer

You may not have heard these words before. 'Pelvic Exenteration' is a very complex, major surgery that doctors recommend as a last resort in the life of someone battling cancer, when all other treatments have failed. This is not just any surgery. This can be a life-saving hope. That's why it's very, very important to be fully informed about this before making such a serious decision.

Simply put, what is Pelvic Exenteration?

Imagine, this is the most major surgery performed when cancer has spread to the organs in our pelvic area and there is no other way to remove it. What happens is that the cancer and the organs that are likely to spread are completely removed surgically.

Although this surgery is mostly performed on women, in some cases, men also have to undergo this surgery.

Doctors usually only resort to major surgery like this if all other treatments, such as chemotherapy and radiation, have failed to control the cancer. This surgery can reduce the pain caused by the cancer and sometimes even cure the cancer completely. However, it also carries a higher risk of serious complications and a longer recovery time. So, it's important to talk to your doctor about the risks, benefits, and recovery process before making a decision.

Are there main types of this surgery?

Yes, this surgery is divided into three main types depending on how the cancer has spread. In any of these types, the organs of a woman's reproductive system are necessarily removed. That is:

• Uterus: Where a baby develops.
• Cervix: The entrance to the uterus.
• Ovaries: Where eggs are produced.
• Fallopian tubes: Tubes that carry eggs to the uterus.
• Vagina.

Let's look at these three main types in this way to clearly understand them.

Why are you doing such a major surgery?

Doctors make this big decision when they have no other option. This surgery is mainly performed for gynecological cancers that have recurred or are not curable with other treatments. For example:

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

This surgery is also performed in men for conditions such as recurrent urethral cancer, where organs such as their bladder, rectum, and prostate gland are removed.

What happens before and during the surgery?

Preparing for surgery

Before a major surgery like this, your doctor will examine you thoroughly. They will do tests like MRI and CT scans to see exactly how far the cancer has spread. The surgery will be planned accordingly. Also, some medications, such as blood thinners, will be asked to be stopped before the surgery. You will also have to stop eating and drinking the night before the surgery. All of this must be followed exactly as your doctor instructs.

How the surgery is performed

You will be given general anesthesia throughout the surgery, so you will not feel any pain. This surgery can take 10-12 hours or even longer.

• To pass urine: The surgeon may use part of your own intestine to create something like a new bladder. Or, the tubes from your kidneys are connected directly to a small opening made in the skin of your abdomen. This is called a urostomy . Urine is then collected in a bag that is connected to that opening.
• To pass stool: When parts of the large intestine, such as the rectum, are removed, the remaining part of the intestine is connected to an opening made on the skin of the abdomen. This is called a colostomy . A bag can also be connected to this to collect stool.

Although it may be difficult to get used to these methods at first, over time you can live normally.

What happens after the surgery? How is the recovery time?

This is the most challenging time. You may have to stay in the hospital for several weeks. While you are given medication to control the pain, your health is constantly monitored by doctors and nurses.

You will be thoroughly taught how to care for your incisions after surgery and how to clean your newly created colostomy/urostomy bags.

The healing period can take several months.

• You cannot engage in any physical activity for several weeks.
• Depending on the nature of the surgery, you may not be able to sit properly for about 6-8 weeks. You may be able to stand, turn to the side, and lie down with your arms outstretched.
• It's essential to have someone to help you in the beginning.
• Because a large number of organs are removed from the body, the abdominal support is reduced, making it difficult for some people to sit up straight for months or even years. Physical therapy exercises can help strengthen the abdominal muscles.

What are the symptoms that require you to see a doctor immediately?

You will be given regular follow-up appointments after surgery. However, if you experience any of the following symptoms , seek medical advice immediately.

• Bleeding or excessive swelling from the abdominal area.
• Fever, redness, and swelling near the incisions (these are signs of infection).
• Severe stomach pain.
• Difficulty urinating or defecating.
• Persistent nausea and vomiting.
• Constipation.

Pelvic Exenteration, cancer surgery, gynecological cancer, cervical cancer, colostomy, urostomy, women's health