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Anterior, posterior and total exenteration: what each one removes | CION Cancer Clinics
Pelvic exenteration comes in three types, named for which part of the pelvis is removed. Anterior takes the bladder and the organs in front. Posterior takes the rectum and the organs behind. Total takes both. The type decides whether you will have one stoma or two, and it is chosen from where the cancer sits on your scans. This page explains each type and how the decision is made. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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The short answer
What are the three types of pelvic exenteration?
There are three main types, named for which part of the pelvis is removed. Anterior exenteration takes the bladder and the organs in front. Posterior exenteration takes the rectum and the organs behind. Total exenteration takes both, front and back, in one piece.
Why the names matter to you
The type decides how many stomas you will have. A stoma is a new opening on the abdomen through which urine or stool leaves the body. Anterior means one stoma, for urine. Posterior means one stoma, for stool. Total means two. If your surgeon has used the word "exenteration" without saying which, this is the first question to ask.
What every type has in common
In women, all three usually remove the womb, the cervix and part or all of the vagina, because these sit in the middle and are most often where the cancer started. All three are long operations under general anaesthetic, and all three are followed by weeks of recovery in hospital and at home.
Some surgeons also describe an "extended" or "lateral" exenteration, which reaches out to the side wall of the pelvis. It is a version of one of the three, not a fourth type.Type by type
Anterior, posterior and total, side by side
Your surgeon chooses the type from where the cancer sits on the scans, not from what is easiest to do.
Anterior exenteration
Removes the bladder, the urethra and, in women, the womb, cervix and front wall of the vagina. The rectum is left in place, so you continue to pass stool normally.
Usually chosen when
- The cancer has grown forward into the bladder
- The rectum is clear on scans and examination
Posterior exenteration
Removes the rectum and, in women, the womb, cervix and back wall of the vagina. The bladder stays, so you pass urine as before. Stool leaves through a colostomy on the abdomen.
Usually chosen when
- The cancer has grown backward into the rectum
- The bladder is clear
Total exenteration
Removes the bladder, the rectum and everything between them. This is the largest of the three and ends with two stomas, one for urine and one for stool. It is chosen when the cancer has reached both the front and the back of the pelvis.
In men, total exenteration removes the prostate and seminal vesicles along with the bladder.Not sure whether this applies to you?
Ask an oncologistSide by side
Anterior and posterior, compared
Anterior
Posterior
Bladder removed; rectum kept
Rectum removed; bladder kept
One stoma, for urine, made from a piece of small bowel
One stoma, for stool, made from the remaining large bowel
You pass stool the usual way afterwards
You pass urine the usual way afterwards
Wound is mostly on the abdomen
Often a second wound between the legs, which heals more slowly
Front wall of the vagina usually removed
Back wall of the vagina usually removed
How the type is decided
How does the team decide which type you need?
Scans of the pelvis
An MRI shows which organs the cancer touches and which it has grown into. A PET-CT (a scan that shows active cancer cells anywhere in the body) checks that the disease has not spread beyond the pelvis, because if it has, exenteration is usually not offered.
An examination under anaesthetic
Many surgeons examine the pelvis with you asleep, sometimes with a camera in the bladder or rectum. This tells them whether the cancer is fixed to the side wall, which a scan can suggest but not settle.
The tumour board
Surgical, medical and radiation oncologists, a radiologist and a pathologist review the case together and agree which organs must come out for the edges to be clear. The type follows from that list.
The conversation with you
The surgeon explains the type proposed, what it removes, how many stomas it leaves and what the alternatives were. Bring the family member who will help you decide, and ask for it in writing.
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Commonly believed
Three things families ask about the type
"Anterior is the mild version, so it should be easy."
Anterior removes fewer organs than total, but it is still a major operation with a new route built for urine, a long anaesthetic and a stay in hospital measured in weeks. Smaller than total does not mean small.
"We should ask for the type that avoids a stoma."
Every type of exenteration ends with at least one stoma, because the bladder or the rectum is removed. The type is set by where the cancer is, not by preference. What you can ask about is whether an internal pouch for urine, or a vaginal reconstruction, is suitable for you.
"The type is fixed once the scans are done."
Usually it is, but not always. If the surgeon finds cancer in an organ the scans called clear, an anterior operation can become a total one on the day, or the operation can be stopped. Your consent form will usually cover this, and you should ask the surgeon to talk you through it before you sign.
Being straight with you
What this page cannot tell you
This page cannot tell you which type you need, or whether any type is right for you. That comes from your scans, your examination and a team discussion of your case, and the decision is one the treating team makes with you, not one a website makes for you.
Who none of the three types suits
Exenteration is not usually offered when the cancer has spread outside the pelvis, when it is fixed to the pelvic bones or the main nerves in a way that cannot be freed, or when the person is not fit enough for a very long anaesthetic. In those cases the team will talk about other treatments, and that conversation deserves the same care.
What the type does not tell you
The type describes what is removed. It says nothing about how the cancer will behave afterwards, and no honest surgeon will attach an outcome to the name of an operation. If you want to understand what to expect, ask about the stage of the cancer, whether the edges are likely to be clear, and what follow-up will look like.
Questions worth taking to the appointment
Which type is proposed, and why. What would change the plan on the day. How many stomas, and where they will sit. Whether any reconstruction is planned. Who will look after me in the first weeks at home.
If the surgeon's letter uses words you do not understand, call the helpline and an oncologist will read it with you.
Did you know
The stoma sites are marked on your abdomen while you are awake, sitting and standing, in the days before the operation. That is so the openings land where you can see and reach them, away from skin folds and your waistband. Ask to be marked if nobody has offered.
Questions we are asked
Common questions about the types of exenteration
Which type is the most common?
It depends on the cancer. For cervical cancer that has come back after radiotherapy, total and anterior exenteration are both common because the cancer tends to grow forward into the bladder. For a rectal cancer that has spread forward, posterior or total is more usual. Your surgeon will explain why yours fits one type rather than another.
Does anterior exenteration mean I keep my bowel?
Yes. The rectum and the rest of the large bowel stay, and you pass stool the usual way afterwards. A short piece of small bowel is borrowed to make the new route for urine, which is why the bowel is still handled during the operation and why eating restarts slowly.
What is a supralevator or infralevator exenteration?
These describe how low the operation goes. The levator muscles form the floor of the pelvis. Supralevator stays above that floor and leaves the anus and the muscles around it. Infralevator goes through the floor and removes them, leaving a wound between the legs that needs its own healing time.
Can a posterior exenteration be done without a permanent colostomy?
Occasionally, if the cancer sits high enough for the surgeon to rejoin the bowel above the anus. Even then a temporary stoma is often made to let the join heal. More often the colostomy is permanent. Ask your surgeon which is planned for you, and do not assume from what happened to someone else.
Is total exenteration ever done in men?
Yes, usually for a rectal, prostate or bladder cancer that has grown into the organs next to it. In men the bladder, prostate, seminal vesicles and rectum are removed together. Erections are affected, and your surgeon should raise this before the operation rather than leave you to discover it after.
Why did my report say "extended" exenteration?
Extended, or lateral, means the surgeon also removed tissue from the side wall of the pelvis, sometimes including muscle, a piece of bone or a nerve, because the cancer reached that far. It is done at a small number of specialist centres and carries more risk. Ask what was taken and what that means for walking and leg strength.
Can the type change during the operation?
Yes. If the surgeon finds cancer in an organ the scans called clear, the operation may be widened, or stopped if the disease has spread further than expected. Your consent form usually covers both possibilities. Ask the surgeon to explain what would make them stop, so that the news is not a surprise.
Is there a type that keeps the vagina?
Part of the vagina can sometimes be kept, and a new vagina can sometimes be made from a flap of skin and muscle during the same operation. Whether either is possible depends on where the cancer sits, not on the type alone. It has to be planned before the operation, so raise it early if it matters to you.
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Sources
- Cancer Research UK — Pelvic exenteration for cervical cancer
- Macmillan Cancer Support — Surgery for cancer
- National Cancer Institute — Cervical Cancer Treatment (PDQ) - Patient Version
- American Cancer Society — Surgery for Cervical Cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Pelvic Exenteration: What the Operation RemovesOrgan by organ, what goes and what staysWho Is a Candidate for Exenteration?What the team weighs before offering any typeLiving With Two StomasWhat total exenteration means day to dayVaginal Reconstruction After ExenterationWhat can be rebuilt, and when it must be plannedDeciding on Cancer SurgeryHow to weigh a large operation with your team
Talk to us
Not sure which type has been proposed?
Send us the scan report or the surgeon's letter, or call the helpline. A surgical oncologist will explain what is being planned and what to ask. One helpline serves every CION centre.