ABSTRACT
In some patients, pelvic clearance includes resection of the pelvic floor and perineum. If perineal resection is extensive, reconstruction with skin and muscle flaps is needed. Previously, tumor involvement of the iliac vessels rendered the patient ineligible for pelvic clearance, but recent improvements in surgical techniques and perioperative support mean that vascular resection and grafting can be contemplated. Tumor infiltration into the sacrum below S2/S3 can be treated by partial sacrectomy and recent extended exenteration procedures have included sacral resection above S2/S3 and the use of bone grafts to reconstruct the pelvic ring. Previously, pelvic sidewall invasion was considered a contraindication to pelvic clearance, but in the United States of America and some European countries, patients with sidewall disease may be treated by muscle and bone resection often with concurrent high dose rate intraoperative radiotherapy.
