Pelvic exenteration may be performed for:
• advanced stage IV cervical carcinoma.
• locally advanced rectal adenocarcinoma.
• recurrent cervical, rectal or anal carcinoma with no evidence of distant metastasis.
• certain sarcomas, e.g., malignant fibrous histiocytoma or locally invasive tumours such as aggressive angiomyxoma. The pelvis is a common site for both types of tumour, which may be associated with advanced pelvic disease without distant metastasis elsewhere.
• pelvic exenteration may be used occasionally for advanced endometrial adenocarcinoma with involvement of the vagina but is generally not recommended in ovarian carcinoma as there is usually peritoneal disease outside the pelvis. Advanced vaginal or vulval squamous carcinoma with involvement of the rectum or urinary bladder may rarely be treated by pelvic exenteration but such locally advanced disease is frequently accompanied by pelvic side wall involvement or nodal metastasis.
• aggressive muscle-invasive transitional carcinoma can be treated by cystoprostatectomy or variants of pelvic exenteration. Prostatic carcinoma may be treated by radical prostatectomy in certain circumstances but pelvic exenteration has no role in the management of locally advanced prostatic carcinoma, as such disease is almost invariably accompanied by distant metastatic spread.
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