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Pelvic exenteration: what the operation removes | CION Cancer Clinics
Pelvic exenteration removes the organs of the pelvis that a cancer has grown into: usually the bladder, the rectum, and in women the womb, cervix and vagina, along with the tissue between them. Which of these are taken depends on where the cancer sits. Because the bladder and bowel are removed, the operation also creates one or two new openings on the abdomen. This page explains, organ by organ, what goes and what stays. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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The short answer
What does pelvic exenteration actually remove?
Pelvic exenteration removes the organs in the pelvis that a cancer has grown into or sits pressed against. In most cases that means the bladder, the rectum, and in women the womb, cervix and vagina, all taken out together as one piece. Because the bladder and bowel go, the surgeon also makes one or two new openings on the abdomen, called stomas, for urine and stool to leave the body.
Why so much is taken at once
The organs in the pelvis sit tightly against each other with very little space between them. When a cancer has spread from one into the next, cutting between them would leave cancer cells behind at the edge. Taking the whole group out in one block gives the pathologist a clear rim of healthy tissue to check, which is the point of the operation.
What is usually left behind
The kidneys stay. The upper bowel stays. The bones of the pelvis, the big blood vessels and the main nerves to the legs are normally left alone. Your surgeon will tell you before the operation exactly which organs are on the list for you, because the list is not the same for everyone.
If you have been told the word "exenteration" and nothing else yet, ask which type is planned. Anterior, posterior and total remove different organs.Organ by organ
What goes, and what takes its place
Not every card applies to every patient. Your operation note will list only the ones that were removed in your case.
The bladder
Removed when the cancer has grown into its wall. The kidneys carry on making urine as before, so a new route out is built from a short piece of bowel. The urine then drains into a bag on the abdomen.
Replaced by
- A urostomy (ileal conduit) in most cases
- Rarely, an internal pouch
The rectum and lower bowel
Removed when the cancer involves the back of the pelvis. The bowel above is brought out to the skin as a colostomy. In some operations the anus and the skin around it are removed too, and that wound is closed separately.
Replaced by
- A colostomy, usually permanent
The womb, cervix and vagina
These sit between the bladder and the rectum, and most exenterations are done for a cancer that started here. The ovaries are often removed too. Part or all of the vagina may go.
Vaginal reconstruction is possible for some women and is decided before the operation, not after.The prostate and seminal vesicles
In men, these are removed along with the bladder because they are joined to it. Erections are affected, and your surgeon should say so plainly before you decide.
Not sure whether this applies to you?
Ask an oncologistInside the operation
How the removal happens, stage by stage
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A look before committing
Many surgeons start by looking inside the abdomen with a camera or through the opening cut. If cancer is found somewhere the scans did not show, the plan can change at this point, and you will be told why.
-
Freeing the organs from the side walls
The block of organs is separated from the pelvic bones, the big blood vessels and the nerves. This is the slow, careful part of the day.
-
Removing everything as one piece
The bladder, bowel and gynaecological organs are lifted out together, not one at a time. The whole piece goes to the laboratory, where the edges are checked for cancer cells.
-
Building the new routes out
A short length of bowel is shaped into a tube for urine and brought to the skin. The remaining bowel is brought out as a colostomy. Each opening is placed on a spot marked on your abdomen before the day.
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Filling and closing the pelvis
The empty space left behind is filled, often with a flap of muscle and skin moved in from the abdomen or thigh, so that the bowel above does not drop into it. Then the wounds are closed and drains are left in.
On the operation note
Words you will read, in plain language
- Exenteration
- The removal of several pelvic organs together. It is not one fixed operation; the word covers a family of them.
- En bloc
- French for "as one block". It means the organs were taken out joined together rather than separated first.
- Margin
- The rim of healthy tissue around what was removed. A clear margin means the pathologist found no cancer cells at the edge. Your surgeon may write R0 for clear and R1 where cells reached the edge.
- Urostomy or ileal conduit
- The new route for urine, made from a piece of small bowel and ending in an opening on the abdomen.
- Colostomy
- The opening on the abdomen through which stool leaves, after the rectum has been removed.
- Perineum
- The area between the legs. When the anus or vagina is removed, the wound here is closed separately and heals more slowly than the abdomen.
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Commonly believed
Three things families ask about what is removed
"If the bladder is removed, she will need dialysis."
No. Dialysis replaces the kidneys, and the kidneys are not removed. They keep making urine exactly as before. What changes is the route the urine takes out of the body, which now ends in a bag instead of the bladder.
"The surgeon decides on the day what to take out."
The plan is made before the operation from your scans, an examination and the tumour board discussion, and it is explained to you. What can happen on the day is that the surgeon finds something the scans missed and stops or changes course. That is a safety check, not guesswork.
"A smaller operation would be safer. We should ask for that."
A smaller operation that leaves cancer at the edge is usually not safer, because the disease is still there. The team offers exenteration when nothing smaller can remove it all. Asking what the alternatives are is a good question. Asking to shrink the plan is a decision for the surgeon to weigh with you.
Did you know
Every exenteration at CION is discussed at a tumour board, with the surgical, medical and radiation oncologists in the same room, before it is offered. The list of organs to be removed is agreed there, not by one surgeon alone, and you can ask for that discussion to be explained to you.
Being straight with you
What this page cannot tell you
This page describes the operation in general. It cannot tell you which organs will be removed in your case, or whether the operation is the right choice for you. Only the surgeon who has seen your scans and examined you can say that, and it is a decision the treating team makes with you.
It cannot tell you whether everything can be removed
Whether all the cancer can be taken out with a clear edge is judged from the scans before the operation and confirmed under the microscope afterwards. Ask how confident the team is, and what happens if the edge is not clear.
Questions worth asking before you decide
Which organs are on the list for me, and why each one. Will I have one stoma or two. Is any reconstruction planned. What would the team do if they found more disease on the day. Write the answers down, because you will not remember them from a single conversation.
If you have a report or a surgeon's letter you do not understand, call the helpline. An oncologist will read it with you.Questions we are asked
Common questions about what exenteration removes
Are the kidneys removed in pelvic exenteration?
No. The kidneys sit high in the back, well away from the pelvis, and they are left in place. They keep making urine as before. The tubes from the kidneys are joined to a new piece of bowel instead, and the urine drains to a bag on the abdomen.
Will I definitely have two stomas?
Only if both the bladder and the rectum are removed, which is a total exenteration. An anterior exenteration removes the bladder but keeps the bowel, so there is one stoma for urine. A posterior exenteration removes the rectum but keeps the bladder, so there is one stoma for stool. Ask which is planned for you.
Is the ovary removed as well?
Often, yes, in women who have already been through the menopause or where the ovaries sit close to the cancer. In younger women the surgeon may discuss keeping one ovary, or moving it out of the way of any later radiotherapy. Raise it before the operation.
Do they remove the anus too?
Sometimes. If the cancer reaches down towards the anal canal, the anus and the skin around it are removed with the rectum, and the wound between the legs is closed with stitches or a flap. If the cancer sits higher, the anus can be left, though it will not be used for passing stool again.
What is removed in a man?
The bladder, prostate and seminal vesicles together, and the rectum if the cancer involves it. The testicles and penis are not part of the operation. Erections are affected because the nerves run right past the prostate, and your surgeon should talk to you about this before you decide, not after.
What happens to the empty space left in the pelvis?
It is filled, usually with a flap of muscle and skin moved in from the abdomen or thigh, or with a piece of the lining of the abdomen. This stops loops of bowel from dropping into the hollow and sticking there, and it helps the wound between the legs heal.
Can the surgeon put back anything later?
The organs themselves cannot be put back. What can sometimes be done later is reconstruction, such as building a new vagina, or in rare cases converting a urine bag to an internal pouch. These are separate operations with their own risks. Ask early if this matters to you.
Will the pathology report say if all the cancer was removed?
It will say whether cancer cells were found at the edge of what was removed, which is the closest anyone can come to that answer. A clear margin is a good sign. It is not a promise that no cells travelled elsewhere before the operation, which is why follow-up scans continue afterwards.
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Dr. C. Raghavendra Reddy
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Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
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Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
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Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
Surgical Oncologist
Surgical Oncologist
Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
Surgical Oncologist
Radiation Oncologist
Radiation Oncologist
Radiation Oncologist
Hematologist
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
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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
Anterior, Posterior and Total ExenterationWhich organs each type removesLiving With Two StomasWhat the two new openings mean day to dayUrinary Diversion After ExenterationHow urine leaves the body once the bladder is goneThe Pathology Report After SurgeryWhat 'margin' and 'R0' mean on the reportPelvic ExenterationThe full guide to this operation
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Been told you may need exenteration?
Send us the scan report or the surgeon's letter, or call the helpline. A surgical oncologist will go through what is being proposed and what to ask. One helpline serves every CION centre.