What is a total pelvic exenteration?
July 25, 2025
Medically Reviewed | Last reviewed by on July 07, 2025
¡°Exenteration¡± refers to a complex surgery in which organs, bones and other structures are removed from the pelvis in order to treat cancer. A pelvic exenteration might involve the bladder, rectum, anus and/or sacrum (tailbone), as well as the prostate gland in men and the vagina and/or uterus in women.
While this procedure may sound fairly extreme, it is often the best ¡ª and only potentially curative ¡ª option for some types of cancer. It also provides the best possible chance of long-term cancer control.
But which cancers does a pelvic exenteration typically treat? What makes you a good candidate for one? How will it affect your sex life and bathroom habits? And, what else should you know about this life-changing operation? Read on for answers.
Which cancers is a total pelvic exenteration used most frequently to treat?
A total pelvic exenteration (TPE) is most commonly used for locally advanced rectal cancer or another type of cancer that involves the rectum. This is because of the way cancer grows and spreads in the rectum. But TPE is also used to treat:
In fact, pelvic exenteration was originally designed to treat recurrent cervical cancer. It originated as an operation for this gynecologic cancer because the cervix is located in the center of the pelvis. In the days before HPV vaccinations prevented most cervical cancers and radiation therapy was used to treat it, cervical cancer often grew into the structures around it. This procedure was seen as a way of clearing it out.
Are there different types of exenterations?
An exenteration used to treat rectal cancer usually involves the removal of the rectum, plus something else. That could be the bladder, the bone behind the rectum (the sacrum), or any of the other structures surrounding it that are not normally removed during rectal surgery. Generally speaking, though, there are three types of exenterations:
Anterior exenteration
In a male, this entails removing the bladder and the prostate, but leaving the rectum intact. In a female, this involves removing the bladder, uterus and possibly the vagina, but leaving the rectum intact.
Posterior exenteration
This involves the removal of the rectum and sacrum, as well as the uterus (if present) and possibly part of the vagina in a female.
Total pelvic exenteration
In a male, this involves removal of the rectum, bladder and prostate. In a female, this normally entails the removal of the rectum, bladder and uterus (if present) and can also include the vagina.
Which patients make the best candidates for an exenteration?
Ideally, we want you to be at your very fittest before an exenteration. That way, you¡¯ll have some strength in reserve if any complications arise. So, any therapies we might recommend before that are all part of a plan to get your body prepared for surgery, not to help you avoid it.
Your best chance for a cure is when we can do a TPE early as a planned part of your treatment, rather than waiting to do it as a last resort when systemic treatments are no longer working. But a TPE is a long and very complex operation, and the recovery can be prolonged. Not all patients will be able to undergo it. So, the first thing we ask is, ¡°Do you have a cancer that¡¯s resectable?¡± That is: ¡°Can your tumor be removed with surgery? Then, your surgeon will determine if you are fit enough to undergo it.
Unfortunately, a lot of patients are told elsewhere that this type of surgery is impossible, even when their cancer is not metastatic and is still potentially curable. They only come to MD Anderson after other treatments have failed. Other patients are so leery of the procedure itself that they¡¯ll try almost anything to avoid it.
The trouble is that while chemotherapy and radiation therapy can sometimes slow a cancer¡¯s growth, the problems caused by a locally advanced tumor in the pelvis often become worse. These can include severe pain, obstructions, infections, blood supply problems, and nerve damage. All of those may end up becoming much bigger issues than they would¡¯ve been if someone had gotten the surgery earlier.
Key takeaways
- An exenteration is a complex surgery in which organs, bones or other structures are removed from the pelvis in order to treat cancer.? ? ?
- An exenteration might involve the bladder, rectum, anus and/or sacrum (tailbone), as well as the prostate in men and the vagina and/or uterus in women.? ? ??
- While it may sound fairly extreme, exenteration is often the best ¡ª and only potentially curative ¡ª option for some types of cancer.?
What are the risks of a total pelvic exenteration?
Any surgery carries some risk, and TPE is a big operation. Complications are not uncommon. So, we counsel patients up front about this and try to have detailed discussions about it before the surgery so they¡¯ll know what to expect.
Most complications will be minor and require simple interventions, such as decompression of the stomach with a small tube through the nose or reopening part of the wound for additional care. Much less common are major complications that require going back into surgery.
But the biggest challenge with a TPE early on is usually wound healing. When organs and other structures are removed, we have to fill that space with something else in order to help it heal. That can involve tissue rearrangement or ¡°flap reconstruction.¡± Our plastic surgeons play an important role in facilitating that.
TPEs also typically involve a relatively long recovery period. It could take as long as six months for you to fully heal. But physical therapists and rehabilitation specialists optimize our patients¡¯ recovery.
Sitting after an exenteration may also be uncomfortable for a while, especially for patients who are very thin and do not have a lot of soft tissue on their bottoms. Everyone¡¯s experience is a bit different, of course, but that generally gets better over time.
Some patients may also experience post-operative pain. Our Supportive Care and Pain Management teams can help with that.
How do you use the bathroom after an exenteration?
The answer depends entirely on which organs you have removed. Usually, a TPE means you¡¯re going to need a permanent colostomy to collect stool. But not always. Similarly, if your bladder is removed, you¡¯ll need a permanent urostomy to collect urine.
But every exenteration is different, so talk to your care team about what yours will involve so you¡¯ll know exactly what to expect.
How will my sexual function be affected by an exenteration?
Again, the answer depends on your particular situation. But it¡¯s probably not going to be the same, so it¡¯s important to have a conversation about it with your care team.
For everything to work right and have sensation, nerves must remain intact. With a TPE, nerves are often compromised by tumors and need to be removed. So, men may lose their ability to get and keep an erection, have penetrative sex, or ejaculate.
If the nerves connected to the clitoris remain intact, women may still experience sexual sensation. But if you have all or part of the vaginal canal removed, it would need to be reconstructed in order to have that type of penetrative sex.
Vaginal reconstruction considerably complicates a TPE because you have to bring that tissue in from somewhere else. So, not all women choose to have one. Retaining that type of sexual function just isn¡¯t important to some of our female patients.
For other patients, though, it really is. So, we have a team of specialists who focus exclusively on these areas. For men, we have urologists dedicated to restoring male sexual function. Medications, injections and implants are sometimes an option. For women, we have reconstructive plastic surgeons and gynecologists dedicated to sexual health who can help them with dryness and other issues.
What should I look for when deciding where to have my exenteration?
Not all local providers even know that an exenteration is possible. So, any time you need something that goes beyond regular rectal surgery, you need to seek out a highly specialized cancer center. MD Anderson is one such center. Our surgeons are some of the only ones in the nation who perform these complex procedures.
You¡¯ll also get a better outcome from a high-volume hospital like MD Anderson. You want a facility where doctors perform a particular procedure frequently, not just once or twice a year. Our surgeons perform between 60 and 70 exenterations a year. That¡¯s more than one a week.
But a successful exenteration requires more than colorectal surgeons. This is a very specialized type of surgery, and it requires many different experts with a lot of experience. We have entire teams who routinely work together to perform exenterations. They include:
- urologists when the bladder is involved,
- neurosurgeons or orthopedic surgeons when the sacrum or other bone structures are involved,
- plastic surgeons for reconstructive procedures, and
- radiation oncologists when radiation therapy is needed during the surgery.
We also have specialists available to help you with survivorship issues afterward.
How good will my quality of life be after a pelvic exenteration?
There¡¯s no question that quality of life can be negatively impacted after any radical operation. But studies show that over time, quality of life among patients who are able to undergo surgery like TPE is better than that of patients who were unable to undergo surgery to remove their cancer.
Still, attitude is everything with a procedure like this one. A pelvic exenteration is a daunting prospect. But many people have done extremely well after one, and you can, too.
, is a surgical oncologist who specializes in the treatment of colorectal cancers.
or call 1-877-632-6789.
Attitude is everything with a procedure like this one.
George Chang, M.D.
Physician