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Pelvic exenteration

Pelvic exenteration is surgery that involves removing all or most of the organs in the pelvis. 

The information on this page is about a major surgery that is used to treat advanced cervical cancer. This may be difficult or upsetting to read, so remember to take care of yourself – you may prefer to read it in sections or ask a loved one to read it with you. We are also here if you need support by phone, email and online.

Get support > 

On this page:

In this section:

What is pelvic exenteration?

Your pelvis is the area between your hips, under your tummy and above your legs. Your pelvis contains:

  • bones
  • muscles
  • nerves
  • blood vessels.

Your pelvis also contains these organs:

  • uterus
  • ovaries and fallopian tubes
  • cervix
  • vagina
  • rectum (back passage)
  • bladder
  • urethra.

Pelvic exenteration is a major surgery that removes all or most of these organs. Sometimes, the aim is to cure advanced cervical cancer,  but this isn’t the case for everyone. 

Who can have pelvic exenteration?

You may be able to pelvic exenteration if you meet all of the following criteria:

  • You have cervical cancer that has come back after other treatments, such as chemotherapy and radiotherapy (chemoradiation).
  • The cancer has not spread outside of your pelvis.   
  • You are otherwise fit and well enough to recover from major surgery. 

You will need to have tests and scans to see if pelvic exenteration is right for you. 

Read about pre-operative assessment >

Types  of pelvic exenteration

There are different types of pelvic exenteration depending on:

  • where the cancer has spread
  • what treatment you have had before 
  • your preferences.

A total exenteration removes the:

  • cervix
  • womb
  • all or part of the vagina
  • bladder
  • lower bowel 
  • rectum (back passage) 
  • urethra
  • other muscles and tissues nearby. 

Sometimes part of the anus and the lymph nodes are also removed.

An anterior exenteration removes the: 

  • cervix
  • womb 
  • ovaries 
  • all or part of the vagina 
  • bladder  

Sometimes this surgery also removes the lymph nodes.

A posterior exenteration removes the: 

  • cervix
  • womb 
  • ovaries
  • all or part of the vagina
  • lower bowel
  • rectum (back passage).

Sometimes this type of surgery removes the anus and lymph nodes. The bladder and urethra are not removed.

A LEER removes the:

  • rectum (back passage)
  • womb
  • some of your bowel
  • the sides of your pelvis 
  • pelvic floor muscles. 

At the time of the surgery to remove the organs, your surgeon will also do reconstructive surgery.

Urostomy and colostomy

You may have reconstructive surgery to make sure you can pass wee and poo out of your body:

  • A urinary diversion or urostomy. This connects the tubes (ureters) from your kidneys to a hole in your stomach. This hole is called a stoma. You may then wear a bag over the stoma to collect wee.
  • A colostomy. This connects the end of your bowel to an opening in your stomach (stoma). You may wear a colostomy bag over the stoma to collect poo.

Vaginal reconstruction

If your vagina is removed, your surgeon can sometimes make a new one. This is called vaginal reconstruction. Not everyone chooses to have a vaginal reconstruction. You can talk about the options with your healthcare team before your surgery.        

Read about vaginal reconstruction on the Cancer Research UK website >

Making decisions about treatment 

Pelvic exenteration is a life-changing surgery that will impact on your day-to-day life, as well as your emotional wellbeing. It is important that you fully understand the surgery before making a decision. 

Your healthcare team will talk to you about:

  • the expected outcome of the surgery
  • the expected recovery time
  • how likely is it that the cancer may return even if you do have the surgery
  • potential short-term and long-term impacts of the surgery
  • the risks and benefits of the surgery
  • other treatment options. 

Before you make a decision, it may help to talk to your clinical nurse specialist (CNS) or a counsellor. They can help you process your emotions about your diagnosis and the surgery, as well as helping you think through the potential impact on your life. If you would like to talk to a counsellor and haven’t already been referred, ask your healthcare team if they can refer you.

You may also want to involve your loved ones, including a partner if you have one, in these discussions. They want be able to offer support, but may also provide a different perspective.

It can be helpful to hear from those who have already had pelvic exenteration. If you would like to be connected with others, contact us at support@jostrust.org.uk We will do our best to put you in touch with someone. 

Your healthcare team will ask you to sign a consent form before the surgery, so make sure you have had enough time to think about everything. 

Read more about making treatment decisions >

Pelvic exenteration during COVID-19

Your immune system protects the body from infection by finding and killing germs, bacteria or viruses. Surgery itself doesn’t usually have a big impact on the immune system. However, getting COVID-19 before or after surgery may increase your risk of complications. 

Your hospital is doing as much as possible to reduce this risk. When your healthcare team are supporting you to make treatment decisions, they will consider the risk of COVID-19 as part of this.

Your healthcare team may talk to you about:   

  • delaying the surgery 
  • changing to a different treatment
  • using telephone calls and video calls to avoid face-to-face appointments where possible.

Your healthcare team will keep you informed about any options they are considering, so you can give your consent.    

Read about COVID-19 and healthcare >

Pelvic exenteration FAQs

Surgery for advanced cervical cancer means major changes to your body and your life, including living with short-term and long-term effects. It also has a risk of serious complications.  

It can be very hard to think about serious risks after pelvic exenteration. Unfortunately, a small number of people die during or just after this type of surgery – research suggests up to 1 in 10 (10%),  Your healthcare team should talk with you about this risk and can give you support you in thinking about this through. You can also get further support from us, including our 1:1 service that offers personal support for 6 sessions. 

Use our 1:1 service > 

Your healthcare team will talk to you about survival after pelvic exenteration. It can be a difficult conversation to have, but it is important to feel prepared.

We need more research to be sure of survival after pelvic exenteration. The research we do have suggests that between about 3 to 6 in 10 (30% to 61%) people who have had pelvic exenteration for a gynaecological reason were still alive after 5 years.    

Thinking about the future in this way can be upsetting, overwhelming, or may be something you don’t want to think about. However you feel, we are here to support you and talk things through. You might find our 1:1 especially helpful. It offers 6 personal sessions with our Support Services Advisor, who can help you explore how you feel and different options.

Use our 1:1 service > 

We can also try to connect you with someone else who has had pelvic exenteration. It may help to see others living their lives, feel good to mutually support each other. You can contact us at support@jostrust.org.uk if this is something you would like. We will do our best to put you in touch with someone.

Getting support before or after pelvic exenteration

We know that pelvic exenteration for advanced cervical cancer is life-changing. It changes your body, your relationship with your body, and can have a huge impact on your emotional wellbeing. Your healthcare team are there to support you with any questions or worries you have. 

Remember that we are here for you too, whether you are waiting to have pelvic exenteration, are in recovery, or are years past it. Sometimes connecting with others who have gone through a similar experience can be helpful. Our online Forum lets our community give and get support. We have a private forum for those with advanced cervical cancer. If you would like to join, we ask for a few details – this is kept private, but means we can make sure this part of the forum is a safe space. You can read through the messages or post your own – whichever feels most comfortable.

If you would like to connect with others who have had a pelvic exenteration, contact us at support@jostrust.org.uk We will do our best to put you in touch with someone.

Join our Forum > 

If you ever need to get in touch with someone quickly, our trained volunteers can listen and help you understand what’s going on. You can call our free Helpline on 0808 802 8000. 

Check our Helpline opening hours > 

If you have general questions about pelvic exenteration, our panel of medical experts may be able to help. They can’t give you answers about your individual situation or health – it’s best to speak with your GP or healthcare team for that.

Use our Ask the Expert service > 

Useful organisations

Colostomy UK

A UK charity that offers information and support on living with and looking after a stoma. 

Helpline: 0800 328 4257

www.colostomyuk.org

Urostomy Association

Offers information and support to people who have, or who will have, a urostomy.

www.urostomyassociation.org.uk

Thank you to all the experts who checked the accuracy of this information, and the volunteers who shared their personal experience to help us develop it.

References

  • British Gynaecological Cancer Society (2020). Cervical Cancer Guidelines: Recommendations for Practice. Web: www.bgcs.org.uk/wp-content/uploads/2020/05/FINAL-Cx-Ca-Version-for-submission.pdf. Accessed October 2020.
  • British Gynaecological Cancer Society (2019). Position Statement on Surgery in Early Stage Cervical Cancer – Lay Summary. Web: www.bgcs.org.uk/wp-content/uploads/2019/07/NCRAS-mas-v-open-radical-hysterectomy-BGCS-lay-statement-May-2019-1.pdf. Accessed October 2020.
  • Li, L. et al (2018). Pelvic Exenteration for Recurrent and Persistent Cervical Cancer. Chinese Medicine Journal (Engl). 131;13. pp.1541-1548. 
  • Westin, S. et al (2014). Overall survival after pelvic exenteration for gynecologic malignancy. Gynecologic oncology, 134;3, pp.546–551. 

We write our information based on literature searches and expert review. For more information about the references we used, please contact info@jostrust.org.uk

Read more about how we research and write our information >

Having a pelvic exenteration >

Find out what happens before, during and after pelvic exenteration surgery.

"Speaking to other people who have been through similar things has been the most helpful thing by far for me."
Read Alice's story
Date last updated: 
04 Nov 2020
Date due for review: 
01 Nov 2023
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