eMedicine Specialties > Obstetrics and Gynecology > Gynecologic Surgery

Pelvic Exenteration: Workup

Author: Margrit M Juretzka, MD, MS, Assistant Professor of Gynecologic Oncology, Stanford University Hospital and Clinics
Coauthor(s): Nelson Teng, MD, PhD, Associate Professor, Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Stanford School of Medicine; Amreen Husain, MD, Assistant Professor, Department of Gynecology and Obstetrics, Stanford University School of Medicine
Contributor Information and Disclosures

Updated: Dec 22, 2008

Workup

Laboratory Studies

  • Preoperative laboratory evaluations should include the following:
    • CBC count
    • Comprehensive metabolic panel
    • Coagulation studies
    • Type and crossmatch for blood products
  • Because most patients have received prior treatment, including pelvic radiation therapy, an increased likelihood exists of preoperative anemia and, occasionally, neutropenia. A large number of patients also have poor nutritional status and electrolyte abnormalities.
  • Other testing depends on the existence of other comorbid conditions in individual patients.

Imaging Studies

  • The use of imaging studies in evaluating a patient for pelvic exenteration depends on the initial assessment of tumor size and location.
  • Most patients need a CT scan of the abdomen and pelvis and a chest radiograph. Other imaging studies may be used as needed for evaluation of potential areas suspicious for metastatic involvement.
    • Chest radiograph or CT scan
    • CT scans of abdomen and pelvis
    • MRI to evaluate musculoskeletal involvement, particularly in the assessment of pelvic side wall disease as well as major pelvic vessel involvement in large lesions
    • Liver ultrasonography to evaluate for metastatic disease
    • Bone scan to evaluate for metastatic disease
    • Positron emission tomography (PET) scanning: PET scanning remains investigational in the evaluation of cervical cancer but may be very useful in excluding small areas of distant metastatic disease. A recent prospective study of 18FDG-PET scan reported a sensitivity of 100% and specificity of 73% in detecting extrapelvic metastasis prior to exenterative procedures in patients with recurrent cervical and vaginal carcinomas.18

Other Tests

  • Psychosocial assessments of patient's ability to adequately manage postoperative physical and psychological issues
  • Assessment of comorbid conditions

Diagnostic Procedures

  • Biopsy confirmation of recurrent cancer

Histologic Findings

Most cervical cancers are squamous cell carcinomas, though the incidence of adenocarcinomas of the cervix is rising. Rare histologic types are occasionally encountered and include adenosarcomas, uterine sarcomas, and cervical or vulvar melanomas.

More on Pelvic Exenteration

Overview: Pelvic Exenteration
Workup: Pelvic Exenteration
Treatment: Pelvic Exenteration
Follow-up: Pelvic Exenteration
References
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References

  1. Brunschwig A. Complete excision of the pelvic viscera for advanced carcinoma. Cancer. 1948;1:177.

  2. Eifel P, Berek JS, Thigpen JT. Cancer of the cervix, vagina and vulva. In: Cancer Principles and Practice of Oncology. Philadelphia, Pa: Lippincott Williams & Wilkins; 1997:1433-1478.

  3. Hatch KD, Gelder MS, Soong SJ, et al. Pelvic exenteration with low rectal anastomosis: survival, complications, and prognostic factors. Gynecol Oncol. Sep 1990;38(3):462-7. [Medline].

  4. Husain A, Curtin J, Brown C, et al. Continent urinary diversion and low-rectal anastomosis in patients undergoing exenterative procedures for recurrent gynecologic malignancies. Gynecol Oncol. Aug 2000;78(2):208-11. [Medline].

  5. Miller B, Morris M, Rutledge F, et al. Aborted exenterative procedures in recurrent cervical cancer. Gynecol Oncol. Jul 1993;50(1):94-9. [Medline].

  6. Morley GW, Hopkins MP, Lindenauer SM, Roberts JA. Pelvic exenteration, University of Michigan: 100 patients at 5 years. Obstet Gynecol. Dec 1989;74(6):934-43. [Medline].

  7. Morrow CP, Curtin JP. Surgery for cervical neoplasia. In: Gynecologic Cancer Surgery. First ed. Churchill Livingstone; 1996.

  8. Penalver MA, Barreau G, Sevin BU, Averette HE. Surgery for the treatment of locally recurrent disease. J Natl Cancer Inst Monogr. 1996;(21):117-22. [Medline].

  9. Penalver MA, Angioli R, Mirhashemi R, Malik R. Management of early and late complications of ileocolonic continent urinary reservoir (Miami pouch). Gynecol Oncol. Jun 1998;69(3):185-91. [Medline].

  10. Plante M, Roy M. The use of operative laparoscopy in determining eligibility for pelvic exenteration in patients with recurrent cervical cancer. Gynecol Oncol. Dec 1995;59(3):401-4. [Medline].

  11. Rose PG, Blessing JA, Gershenson DM, et al. Paclitaxel and cisplatin as first-line therapy in recurrent or advanced squamous cell carcinoma of the cervix: a gynecologic oncology group study. J Clin Oncol. Sep 1999;17(9):2676-80. [Medline].

  12. Rutledge FN, Smith JP, Wharton JT, O'Quinn AG. Pelvic exenteration: analysis of 296 patients. Am J Obstet Gynecol. Dec 15 1977;129(8):881-92. [Medline].

  13. Stehman FB, Perez CA, Kurman RJ. Uterine cervix. In: Principles and Practice of Gynecologic Oncology. 3rd ed. Lippincott Williams & Wilkins; 2000:841-918.

  14. Sugiyama T, Yakushiji M, Noda K, et al. Phase II study of irinotecan and cisplatin as first-line chemotherapy in advanced or recurrent cervical cancer. Oncology. 2000;58(1):31-7. [Medline].

  15. Höckel M. Laterally extended endopelvic resection. Novel surgical treatment of locally recurrent cervical carcinoma involving the pelvic side wall. Gynecol Oncol. Nov 2003;91(2):369-77. [Medline].

  16. Goldberg GL, Sukumvanich P, Einstein MH, Smith HO, Anderson PS, Fields AL. Total pelvic exenteration: the Albert Einstein College of Medicine/Montefiore Medical Center Experience (1987 to 2003). Gynecol Oncol. May 2006;101(2):261-8. [Medline].

  17. Long HJ 3rd, Bundy BN, Grendys EC Jr, Benda JA, McMeekin DS, Sorosky J, et al. Randomized phase III trial of cisplatin with or without topotecan in carcinoma of the uterine cervix: a Gynecologic Oncology Group Study. J Clin Oncol. Jul 20 2005;23(21):4626-33. [Medline].

  18. Husain A, Akhurst T, Larson S, Alektiar K, Barakat RR, Chi DS. A prospective study of the accuracy of 18Fluorodeoxyglucose positron emission tomography (18FDG PET) in identifying sites of metastasis prior to pelvic exenteration. Gynecol Oncol. Jul 2007;106(1):177-80. [Medline].

  19. Tran PT, Su Z, Hara W, Husain A, Teng N, Kapp DS. Long-term survivors using intraoperative radiotherapy for recurrent gynecologic malignancies. Int J Radiat Oncol Biol Phys. Oct 1 2007;69(2):504-11. [Medline].

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Further Reading

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Keywords

pelvic exenteration, anterior exenteration, posterior exenteration, total exenteration, radical resection, supralevator exenteration, infralevator exenteration, vaginectomy, urethrectomy cervical cancer, vaginal cancer, vulvar cancer, uterine cancer, chemotherapy, intraoperative radiation therapy, IORT, ovarian cancer, cervical cancer, squamous cell carcinoma, adenocarcinomas of the cervix, rectal anastomosis, urinary diversion, vaginal reconstruction

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Contributor Information and Disclosures

Author

Margrit M Juretzka, MD, MS, Assistant Professor of Gynecologic Oncology, Stanford University Hospital and Clinics
Margrit M Juretzka, MD, MS is a member of the following medical societies: American College of Obstetricians and Gynecologists and Society of Gynecologist Oncologists
Disclosure: Nothing to disclose.

Coauthor(s)

Nelson Teng, MD, PhD, Associate Professor, Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Stanford School of Medicine
Disclosure: Nothing to disclose.

Amreen Husain, MD, Assistant Professor, Department of Gynecology and Obstetrics, Stanford University School of Medicine
Amreen Husain, MD is a member of the following medical societies: American Association for Cancer Research, American College of Obstetricians and Gynecologists, and Society of Gynecologist Oncologists
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey B Garris, MD, Chief, Assistant Professor, Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, Tulane University School of Medicine
Jeffrey B Garris, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Medical Association, American Urological Association, Association of Professors of Gynecology and Obstetrics, Louisiana State Medical Society, Royal Society of Medicine, and Sigma Xi
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michel E Rivlin, MD, Professor, Coordinator of Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD, Professor, Coordinator of Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

 
 
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