Name of the Procedure:

Pelvic Exenteration for Colorectal Malignancy with Proctectomy (with or without Colostomy), Bladder Removal, Ureteral Transplantation, and/or Hysterectomy/Cervicectomy (with or without Removal of Tubes and Ovaries).

Summary

A pelvic exenteration is a complex surgical procedure used to treat advanced colorectal cancer that has spread to surrounding organs. This surgery entails the removal of the rectum and anus (proctectomy), bladder, and sometimes reproductive organs. It may also involve creating alternative pathways for waste elimination, such as a colostomy or ileal conduit.

Purpose

Pelvic exenteration is performed to remove cancerous tissues and organs in the pelvis to prevent the spread of cancer. The goal is to improve survival rates and potentially cure the patient while alleviating symptoms caused by the malignancy.

Indications

• Advanced colorectal cancer that has invaded nearby pelvic organs.
• Recurrent colorectal cancer after initial treatments.
• Patients who are otherwise healthy enough to withstand a major surgical procedure.

Preparation

• Patients may need to fast for several hours before surgery.
• Preoperative tests include a full medical evaluation, imaging studies (CT, MRI), and blood tests.
• Bowel preparation to clear the intestines.
• Discontinuation or adjustment of certain medications.
• Meeting with an ostomy nurse if a colostomy is anticipated.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
2. Incision: A large abdominal incision is made.
3. Organ Removal: The surgeon removes the rectum, anus, bladder, and possibly the uterus, cervix, fallopian tubes, and ovaries, depending on the cancer spread.
4. Reconstruction:
   • Ureters are transplanted to a new urinary conduit or into the colon to reroute urine.
   • If the bladder is removed, a urostomy may be created.
   • Proctectomy may include creating a colostomy.
5. Closure: The surgical site is closed, and drains may be placed to remove excess fluids.

Duration

The procedure typically takes 8-12 hours, depending on its complexity and extent.

Setting

Performed in a hospital's surgical suite equipped for major surgeries.

Personnel

• Lead Surgeon (often a colorectal or oncological surgeon)
• Urological Surgeon (for bladder and ureter work)
• Gynecological Surgeon (if reproductive organs are involved)
• Anesthesiologist
• Surgical Nurses
• Operating Room Technicians

Risks and Complications

• Bleeding
• Infection
• Damage to surrounding organs
• Blood clots
• Complications from anesthesia
• Long-term changes in bowel, urinary, and sexual functions
• Possible need for further surgeries

Benefits

• Potentially curative for advanced or recurrent colorectal cancer.
• Provides relief from symptoms caused by tumor mass effects.
• Can significantly improve quality of life if successful.

Recovery

• Initial ICU stay for monitoring.
• Hospital stay ranging from 1 to 2 weeks.
• Pain management with medications.
• Gradual return to normal activities over 6-8 weeks.
• Follow-up with oncology for ongoing cancer management.
• Learning to care for ostomies or urinary diversions.

Alternatives

• Radiation therapy
• Chemotherapy
• Targeted therapy
• Palliative care for symptom management
• Each alternative carries its own risks and benefits and should be discussed with the healthcare provider.

Patient Experience

Patients might experience:

• Significant postoperative pain, manageable with medication.
• Fatigue and need for extended recovery.
• Physical and emotional adjustments to changes in body function (e.g., colostomy).
• Continuous support from a healthcare team, including pain management specialists and ostomy care nurses.
• Counseling and support groups to help with emotional and psychological recovery.

By addressing the aggressive nature of pelvic tumors, pelvic exenteration aims to provide patients with increased survival chances and symptom relief, but it demands comprehensive preparation and recovery processes.