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Total pelvic exenteration is indicated for persistent or recurrent cervical cancer after radiation therapy. Also, although less commonly, the procedure may be indicated in some instances of recurrent endometrial adenocarcinoma, uterine sarcoma, or vulvar cancer; locally advanced carcinoma of the cervix, vagina, or endometrium when radiation is contraindicated; and melanoma of the vagina or urethra (Hoffman et al., 2012i). The bladder, rectum, uterus, cervix, and surrounding tissues are removed. When less radical surgery, chemotherapy, or radiation options are exhausted, pelvic exenteration may be indicated as a curative procedure. Preoperative evaluation is extensive, searching for any signs of metastatic disease. Counseling is required to prepare the patient for the results of the extensive procedure. Quality of life issues may be significant; sexual function and body image are altered.

• Preoperative preparation includes mechanical bowel cleansing, locating urinary and intestinal stoma sites, and administering antibiotics and deep vein thrombosis (DVT) prophylaxis. Patients are blood typed and cross-matched for replacement red cells. Intraoperative positioning will be in a low lithotomy position. The surgical approach is both abdominal and perineal. Typically, a ureterostomy and colostomy are created; multiple drains will be placed in the abdominal cavity and perineum. Postoperatively, the patient may require intensive care unit admission. Complications include fever, wound breakdown, ileus, bowel obstruction, intestinal fistulas, anastomotic leaks or stricture, and venous thromboembolism. Postoperative care needs include drain and stoma care, hemodynamic monitoring (potential for extensive fluid loss and third spacing), and pain management (Henry, 2016).