Evolution of Pelvic Exenteration

Abstract

Most, if not all, cancer operations as we know them today had been performed successfully by the late 1940s. Surgical advances after World War II, especially in blood transfusion, anesthesia, antibiotic therapy, and later in nutrition and respiratory and intensive care monitoring, made it possible for radical resection procedures such as pancreatoduodenectomy, esophagectomy, radical neck dissection, and abdominoperineal resection of the rectum to become the standard of care in the surgical treatment of malignancy arising from these organs. Total pelvic exenteration is defined as the complete resection of the pelvic viscera and its draining lymphatic system. Although nearly 60 years have passed since Brunschwig [1] published his initial experience in 1948, the value of this procedure was recognized relatively late in the evolution of radical cancer surgery (Fig. 1). The objective of total pelvic exenteration is to encompass all malignant tissues including adjacent invaded viscera and regional lymphatics; therefore, experience with other pelvic radical cancer operations had to mature for exenterative surgery to have a place in the surgical armamentarium against locally advanced pelvic cancer affecting more than one pelvic organ. These ‘‘lesser’’ procedures include radical cystectomy (Verhoogen, 1908), radical hysterectomy (Weirtheim, 1898), and abdominoperineal rectal resection (Miles, 1908). Each is an extensive surgical procedure capable of inflicting substantial morbidity and functional impairment of great magnitude. Eugene M. Bricker, a pioneer in pelvic exenteration, performed his first total exenteration on August 8, 1940, at the newly created Ellis Fischel State