RT Book, Section A1 Magrina, Javier F. A1 Magtibay, Paul M. A2 Bristow, Robert E. A2 Chi, Dennis S. SR Print(0) ID 1115055092 T1 Pelvic Exenteration T2 Radical and Reconstructive Gynecologic Cancer Surgery YR 2015 FD 2015 PB McGraw-Hill Education PP New York, NY SN 9780071808095 LK obgyn.mhmedical.com/content.aspx?aid=1115055092 RD 2024/10/03 AB Exenteration was first reported by Brunchswig in 1948 as a palliative procedure, and, in his subsequent series of 561 patients collected from 1948 to 1964, the operative mortality was 26% and the 5-year survival rate was 20%.1 Advances in anesthesia, surgical instrumentation, technique, pelvic floor reconstruction, antibiotics, fluid management, blood products, the use of intermediate or intensive care units, and the training of gynecologic oncologists have decreased operative mortality; in addition, improved patient selection preoperatively and intraoperatively have increased survival rates. At the Mayo Clinic from 1950 to 1986, the operative mortality rate decreased from 12% to 6.7%, and the 5-year survival rate increased from 26% to 41%.2 Patient rehabilitation has also remarkably improved. From loss of vaginal function and 1 or 2 permanent stomas, reconstructive techniques have resulted in no stoma bags (due to low rectosigmoid anastomosis and continent urinary reservoir), and restoration of vaginal function by using different type of pedicle flaps. Other factors to consider for all exenteration candidates are the need for family support due to long rehabilitation, usually 6 months or longer depending on the extent of the operation and whether there were or not postoperative complications, quality of life before and after surgery, and the need for appropriate care if an exenteration cannot be performed or cure is not achieved.