Empty Pelvis Syndrome Complication Management Following Pelvic Exenteration

Pelvic surgery is becoming more aggressive in order to achieve clear margin resection of locally invasive rectal cancer and recurrent pelvic malignancies including anal, rectal, cervical and endometrial cancer. 5-year survival rates following these procedures are in the region of 40% for all tumours, which compares with < 5% in locally advanced rectal cancer if managed non-operatively. Operative strategies often incorporate multiple pelvic compartments in order to achieve margin clearance. Sacral or other pelvic bony resection is necessitated in many cases. Such resectional strategies lead to large pelvic defects requiring closure following surgery. Strategies employed in closure, range from primary closure, use of adjuncts such as vacuum devices and mesh, to myocutaneous flap reconstruction. Despite these strategies there remains a rate of wound infection, breakdown of perineal closure, long term sinus formation, and indeed entero-atmospheric fistulation. In this chapter we will describe common complications associated with the empty pelvis following pelvic exenterative surgery. We will discuss perineal wound closure; prevention strategies in these patients; recognition and management of complications should they occur.