Reduction of mortality and morbidity associated with pelvic exenteration.

Eighty-seven pelvic exenterations performed on the Gynecology Service at Roswell Park Memorial Institute are reviewed in terms of postoperative mortality and morbidity. Sixty-five of these patients (75%) had one or more significant postoperative complications, and 22 patients (25%) died as a result of these complications. Thirty-four patients (39%) required one or more major reoperations. Complications were associated with dose of previous pelvic radiotherapy, type of exenteration, prolonged operations and excessive blood loss, pelvic lymphadenectomy, hypogastric artery ligation, type of pelvic occlusion, and the diversion of ureters into functional colon. A postexenteration hepatic stress syndrome is described and appears to occur in the majority of patients undergoing this operation. Methods of surgical technique and pre- and postoperative care are discussed which will potentially lead to a reduction in mortality and morbidity.