Total Pelvic Exenteration Abroad

Pelvic Exenteration refers to the radical surgical procedure which involves the removal of the pelvic organs and adjacent structures i.e. the urinary bladder, lower part of the ureters, rectum, anus and the internal reproductive organs (ovaries, fallopian tube, uterus and cervix in females or prostate, seminal vesicles, epididimis and other ducts and glands in males) along with the adjacent lymph nodes, muscles and supporting ligaments. It is also referred to as the Brunchwig’s operation. Total pelvic Exenteration is a complex and a major surgical procedure, which requires a highly trained and skilled medical team for best case management. India, South Korea, Jordan, Mexico and Turkey are the best medical destinations for undertaking the complex surgery.

Need for Total Pelvic Exenteration:

• Total pelvic Exenteration is generally conducted for primary cancers involving any organ in the pelvic cavity, which have failed to respond adequately to chemotherapy or radiation therapy. The procedure is also conducted in cases of recurrence of the primary cancer in the pelvic cavity.
• In females the procedure is performed for invasive and advanced cases of ovarian cancers, endometrial cancers, vaginal cancers and cervical cancers.
• In males the procedure is preferred for aggressive type of prostate cancer.
• The procedure is also conducted for invasive forms of rectal cancer in both sexes.

Survival Rate after Pelvic Exenteration:

The five year survival rate after a pelvic exenteration ranges from 25 % to 60% depending upon the type of procedure that is performed. About one third of the patients develop complications after the surgery with about 3-5% of deaths related to complications.

Preparing for Pelvic Exenteration:

• Prior to the surgery a thorough clinical examination of the rectum and pelvis is conducted.
• To validate the clinical findings endorectal ultrasound or imaging studies (MRI or CT scan) are conducted to understand the spread and expanse of the tumor and to identify the normal tissue.
• In tumors that are very large or have extensive metastasis, chemotherapy and radiotherapy is mandated about six weeks prior to the procedure. The objective is to reduce the size of the tumor to make surgical extraction easier.
• Prior to the procedure, a bowel wash is given to clean the colon and reduce the bacterial count in the colon. This is ideally aimed at reducing the chances of a post operative infection. Antibiotic cover may be essential and is recommended.

The Surgical Procedure of Total Pelvic Exenteration:

There are three major methods by which Exenteration of pelvic organs are done, which depend on the organs involved. The procedure is a major surgery and is conducted under general anesthesia.

• Anterior Exenteration: For cancers involving organs located in the anterior part of the pelvis, this procedure is recommended. The procedure spares the rectum while other structures, namely the female or male reproductive organs, bladder and urethra are removed (the procedure is also referred to as cysto-prostatectomy for male patients as it involves the removal of the bladder and the prostate). In this surgery, an alternative passage for the flow of urine is designed which is called the “ileal conduit”. The ureters are diverted to a pouch in the small intestine (ileum), which is connected to the abdominal wall via a small opening.
• Posterior Exenteration: This entails the removal of organs located in the back of the pelvic cavity, which includes the reproductive organs and the lower part of the bowel. Bladder and urethra are kept intact in this procedure. Similar to the ‘ileal conduit’, a ‘colostomy’ is performed which allows the colon to connect to the abdominal wall to excrete waste through a small opening called the stoma.
• Total Pelvic Exenteration: This procedure is conducted when the location, size of the cancer doesn’t allow any pelvic organ to be spared. In this case both ileal conduit and colostomy are performed to allow excretion of waste.

Post operative Care after total pelvic Exenteration

• Immediately after the surgery, a drain tube is inserted to allow any fluid or blood accumulating at the site of surgery to be drained out.
• The procedure requires a post operative hospital stay for a minimum of five days.
• Initial difficulty during urination may be faced by the patient accompanied with lower abdominal pain.
• Pain killers and antibiotics are prescribed and need to be continued after the surgery for quite some time.

Post operative complications of Total Pelvic Exenteration: 

• Bowel Obstruction
• Formation of a fistula
• Pulmonary embolism due to a blood clot getting logged in the lungs
• Stricture of the ureters causing inflammation or failure of the kidneys
• Extensive blood loss
• A high possibility of urinary tract infections

Total Pelvic Exenteration in India

With well trained and specialized medical teams for the management of surgical oncology procedures, India leads the list of medical tourism destinations. The hospitals across the country provide good quality services and have a medical infrastructure that is comparable to international standards.

Total Pelvic Exenteration in Mexico:

Mexico is preferred by most Americans, as it considerably reduces travel time for patients seeking complex medical and surgical treatment. There are several JCI accredited hospitals in the country which provide first-rate medical and surgical care.

Total Pelvic Exenteration in Turkey:

A sound healthcare infrastructure and affordable prices for medical and surgical care gives Turkey an advantage over other countries. It commands a considerable respect in the Middle East for its medical care services and has a strong and proven track record in the domain of medical care travel.

Total Pelvic Exenteration in Jordan:

Jordan attracts several medical tourists annually, due to its commitment to quality and low cost of medical care. It is one of the fastest growing medical travel destinations in the world. Complex oncological procedures are handled effectively, providing optimum care and support.

Total Pelvic Exenteration in South Korea:

South Korean hospitals specifically focus on providing medical and surgical oncology services to medical tourists from around the world. Considering its experience in this domain, South Korea, is a better choice for medical tourists for the management of complex oncological surgeries.

Resources:

Cyberknife in India
Cyberknife at Anadolu Medical Center, Turkey
Chemotherapy Treatment (CHOP) Abroad
Cyberknife Cancer Radiotherapy Overseas
Radical Gastrectomy Surgery Abroad

Medical Tourism Corporation facilitates Affordable Total Pelvic Exenteration treatment in Europe (Turkey) and other overseas world-class oncology treatment destinations.