Clinical Investigations

Exenterations are performed for advanced or recurrent pelvic malignancy in the absence of extra-pelvic metastatic spread. Patients will usually have been staged by one or more radiological techniques:

CT scanning: this is particularly useful in the evaluation of pelvic and retroperitoneal lympha-denopathy and metastatic disease outside the pelvis. Magnetic resonance imaging has largely replaced CT scanning in the evaluation of the T stage of cervical, endometrial and rectal tumours. Pelvic exenteration is a major surgical procedure and carries with it considerable morbidity and

Figure 34.1. Pelvic exenterations.

mortality. Although occasionally it might be performed as a palliative procedure, it is contraindi-cated if there is evidence of widespread distant metastases.

Magnetic resonance imaging (MRI): this is used to clinically stage cervical, endometrial and rectal cancers preoperatively.

Positron Emission Tomography (PET scanning): PET scanning detects metabolic activity in malignant tumours and in combination with CT (CT-PET) is particularly useful in the identification and localisation of recurrent or metastatic disease.

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