Pelvic exenteration

Pelvic exenteration is surgery to remove multiple organs in the pelvis. It is sometimes used to treat cancers in this area of the body.

The pelvis is the area of the body between the hip bones, in the lower part of the tummy (abdomen). It contains:

• the sex organs
• the bladder
• a section of the small bowel
• the lower end of the large bowel (colon, rectum and anus).

Pelvic exenteration can be used when cancer has:

• spread within the pelvis
• come back in the pelvis after other treatment.

Pelvic exenteration can cure cancer in some people. But it is a major operation. It is important to discuss the benefits and risks with your surgeon, before having it.

Some people have other cancer treatments before having pelvic exenteration surgery. This is called neo-adjuvant treatment. The aim is to try and shrink the cancer before the surgery.

Pelvic exenteration is sometimes called pelvic clearance.

There are different types of pelvic exenteration. The type you are likely to have will depend on your sex and where the cancer is.

We have more information about:

• pelvic exenteration for men and people assigned male at birth
• pelvic exenteration for women and people assigned female at birth.

Pelvic exenteration is a major operation, so your doctors need to make sure you can cope with the surgery. If you have other health problems, it may be more difficult for you to recover from the operation. You may have heart and lung tests. This is to check your general health and fitness.

Your doctor or specialist nurse may give you information about prehabilitation (prehab). Prehab means getting you as ready for treatment as you can be. To help you prepare, your team may give you advice and support about:

• exercise
• healthy diet and weight
• stopping smoking
• reducing alcohol intake
• mental health and wellbeing.

This can help you get fitter for surgery and may help with your recovery. It is important to get advice from your doctor or nurse about exercise and making changes to your diet.

If you have been having problems with eating, or have lost weight, you may be referred to a dietitian. They can help and support you with your diet and nutrition before and after the surgery.

We have more information about preparing for surgery

Your doctors will also do tests to see whether the cancer has spread. They will discuss what tests they think you should have before having the surgery.

After the operation you will be in an intensive care or a high-dependency unit for the first few days. You will stay in hospital for a few days to a few weeks, depending on your recovery.

When you wake up after the operation, you will have dressings on your tummy (abdomen). You may also have dressings on the area between the genitals and back passage. If you have had reconstruction, you may have wounds and dressings on other parts of your body. Your nurse will tell you what to expect and give you advice about how to cope with your dressings and wounds.

You may also have the following:

You will have painkillers when you first wake up from surgery. These will be given either:

• into a vein (intravenously)
• through a tube into the space around your spinal cord (epidural).

The painkillers are usually given continuously through a pump. The pump may have a hand control with a button you can press. This is called patient-controlled analgesia (PCA).

You press the button when you need more painkillers. You can press the button whenever you need it. It is designed so that you cannot give yourself too much. It is important to let the doctors or nurses know if you are still in pain, or if you feel any side effects from the painkillers. They can increase the dose or change the painkillers.

You will have painkillers for a few weeks after the operation. When you are ready to go home, your pain will be controlled with tablets. A nurse will give you tablets to take home.

We have more information about managing pain and painkillers.

After your operation, you will be encouraged to start moving around. The day after your operation, your nurses or physiotherapists will help you get out of bed.

If you have had plastic surgery you may be advised not to sit at first. You will be able to stand and lie on your side in bed. Your nurse will be able to tell you how long to avoid sitting for.

It is important to do regular leg movements and deep breathing exercises when you are not as mobile as you are used to. A physiotherapist will show you how.

They will also show you gentle exercises and give you advice on how and when to start walking. You will find it easier to move around when all your drips and drains have been removed.

The hospital nurses will tell you who will help you with your wound when you go home. You will also get support from a stoma nurse.

You will have injections every day for about 4 weeks. This is to thin the blood, which reduces the risk of blood clots.

The hospital nurses will show you how to inject yourself, so you can do them at home. If you are not able to inject yourself, they will show a partner, family member or friend how to do it. Or they may be able to arrange a district nurse to do it for you.

It is important to try and move around as much as you can, and to keep doing the exercises you were shown in the hospital. This helps with your recovery.

If you have any pain when you are moving or doing your exercises, speak to your doctor or nurse. They may be able adjust your dose of painkillers or change them to one that works better for you.

You may be given special equipment to take home with you. For example, you may be given an air cushion. Only use equipment that your doctor, nurse, physiotherapist or occupational therapist advises.

Your recovery from pelvic exenteration is individual and depends on the type of pelvic exenteration you had. It can take anywhere from a few weeks to a year. Your doctor or nurse will talk to you about what to expect. Build up your activities slowly and only do as much as you feel able to. As time goes on, you will start to feel stronger and have more energy. Talk to your surgeon or specialist nurse if you have any more questions about recovery.

You may want to know when you can:

• go back to work
• drive
• do housework
• get back to sports or other activities.

You will also be recovering emotionally, as well as physically, from the operation. Pelvic exenteration is a major surgery that can change your body and how you feel about your body. This takes time to deal with.

It is important to talk to someone about how you are feeling. This can be a nurse, counsellor, friend, family member or partner. Anyone you feel comfortable with.