7/27/2019 Exenteration

1/3

Exenteration

Definition

Exenteration is a major operation during which all the contents of a body cavity are removed. Pelvic

exenteration refers to the removal of the pelvic organs and adjacent structures; orbital exenteration

refers to the removal of the entire eyeball, orbital soft tissues, and some or all of the eyelids.

PurposeThe pelvis is the basin-shaped cavity that contains the bladder, rectum, and reproductive organs. The

internal reproductive organs include the ovaries, fallopian tubes, uterus, and cervix for women, and

the prostate and various ducts and glands for men. Pelvic exenteration is performed to surgically

remove cancer that involves these organs and that has not responded well to other types of

treatment. Pelvic exenteration is also indicated when cancer returns after an earlier treatment. In

women, the operation is performed mostly for advanced and invasive cases of endometrial, ovarian,

vaginal, and cervical cancer; for aggressive prostate cancer in men; and rectal cancer in either sex.

Orbital exenteration is performed to remove the eye and surrounding tissues when cancer of the

orbital contents cannot be controlled by simple removal or irradiation. It is often the only course of

treatment for advanced cancers of the eyelid, eyeball, optic nerve, or retina.

Exenteration is a major operation for both patient and surgeon; it is technically very challenging

because it involves elaborate reconstructive surgery. Although it is a radical surgical procedure,

exenteration often provides the only opportunity available for patients to eliminate the cancer and to

prevent it from recurring.

DemographicsNo data are available regarding the demographic nature of patients undergoing exenteration, given

the numerous conditions that may warrant it. Cancer affects individuals of any age, sex, race, or

ethnicity, although incidence may differ among these groups by cancer type.

DescriptionBoth pelvic and orbital exenterations are considered to be major surgery and are performed under

general anesthesia. The exact surgical procedure performed depends on the type of exenteration.

Orbit al exenterationThis operation removes the eyeball and surrounding tissues of the orbit. (Since the eye is surrounded

by bone, orbital exenteration is often easier to tolerate than pelvic exenteration.) Orbital exenteration

with partial preservation of eyelids and conjunctiva can sometimes be achieved. After the surgical site

has healed, patients can be fitted with a temporary ocular prosthesis (plastic eye), although many

patients prefer to wear an eye patch. Later, facial prostheses can be attached to the facial skeleton.

Diagnosis/PreparationThe evaluation of patients before pelvic exenteration includes a thorough physical examination with

rectal and pelvic examination. Endorectal ultrasound and imaging studies such as computed

tomography scans (CT scans ) and magnetic resonance imaging (MRI) are routinely used to obtain

pictures of the abdominal and pelvic areas and evaluate the spread of the cancer.

Ocular ultrasound examination, CT scan, and angiography evaluation (used to image blood vessels)

are usually performed to prepare for orbital exenteration.

Some patients begin treatment with chemotherapy and/or radiation before the procedure. Surgery istypically performed approximately six weeks later.

7/27/2019 Exenteration

2/3

In the case of pelvic exenteration, the patient will be given a bowel prep to cleanse the colon and

prepare it for surgery. This procedure is required to lower the level of intestinal bacteria, thus helping

to prevent post-surgical infections. Antibiotics are also typically given to help decrease bacteria

levels in the bowel.

Ocu lar exenterationAfter ocular exenteration, most patients have a headache for several days, which goes away with

over-the-counter pain medications. An eye ointment is also prescribed that contains antibiotics and

steroids to help the healing process.

RisksAs with any operation, there is a risk of complications due to anesthesia, wound infection, or injury to

adjacent organs or structures.

In the case of orbital exenteration, the following complications have been known to occur:

growth of an orbital cyst (rare)

chronic throbbing orbital pain

sinusitis (nasal stuffiness)

ear problems

reoccurrence of malignancy

Normal results

During and after recovery from exenteration, it is normal for a patient to undergo a period of

psychological adjustment to the major change in lifestyle (e.g., learning to care for a urostomy or

colostomy) or appearance (e.g., following orbital exenteration). It is important that all aspects of the

procedure be discussed with the patient before undergoing surgery, and that any psychosocial

distress that the patient experiences after exenteration be addressed.

Morbidity and mortality ratesThere is a 3044% chance of complications during pelvic exenteration, and the operative mortality

rate ranges from 35%. About one-third of patients will experience such postoperative complications

as bowel obstruction, fistula formation, inflammation or failure of the kidneys, narrowing of the ureters,

or pulmonary embolism (a blood clot that travels to the lungs). The five-year survival rate after pelvic

exenteration ranges from 2361%. For patients who undergo pelvic or orbital exenteration, short- and

long-term morbidity and mortality rates depend on the particular condition that required the procedure.

Alternatives

Exenteration is generally pursued only if no other less invasive options are available to the patient.

Alternatives, however, include chemotherapy, radiation therapy, and more conservative surgery.

Resources

booksYanoff, Myron, and Jay Duker. Ophthalmology, 1st ed. London: Mosby International Ltd., 1999.

periodicalsClarke, A., N. Rumsey, J. R. O. Collin, and M. Wyn-Williams. "Psychosocial Distress Associated with

Disfiguring Eye Conditions." Eye 17, no. 1 (January 2003): 3540.

Ramamoorthy, Sonia L., and James W. Fleshman. "Surgical Treatment of Rectal

Cancer."Hematology/Oncology Clinics ofNorth America16, no. 4 (August 2002): 927.

Sevin, B. U., and O. R. Koechlie. "Pelvic Exenteration." SurgicalClinics of North America 81, no. 4

(August 1, 2001): 7719.

http://www.encyclopedia.com/topic/North_America.aspxhttp://www.encyclopedia.com/topic/North_America.aspxhttp://www.encyclopedia.com/topic/North_America.aspxhttp://www.encyclopedia.com/topic/North_America.aspx

7/27/2019 Exenteration

3/3

Turns, D. "Psychosocial Issues: Pelvic Exenterative Surgery." Journal of Surgical Oncology76 (March

2001): 22436.