ABSTRACT
The surgery involved is extensive, and postoperative care is complex; as a consequence, the operation has become part of the repertoire of the advanced gynecological oncologist working in a center with a wide experience of radical surgery. The procedure demands of the surgeon considerable expertise and flexibility: virtually no two exenterations are identical, and considerable judgment and ingenuity are required during the procedure in order to achieve a comprehensive removal of all tumor. With small recurrences, more limited procedures may be carried out with a degree of conservation of structures in and around the pelvis. With extensive procedures, and particularly following extensive radiotherapy, complete clearance of all organs from the pelvis (total exenteration) together with widespread lymphadenectomy may be essential in order to achieve a cure. There is now considerable evidence that even in patients with node metastases at the time of exenteration a significant survival rate can be achieved.
