Extended or ultraradical surgery in the treatment of advanced pelvic cancer is an American innovation made possible by advances in the ancillary sciences. The natural history of many pelvic cancers is that they may be locally advanced yet still limited to the pelvis. They are therefore potentially resectable. Pelvic exenteration were first intrioduced by Brunschwig and Pierce in 1948. However, they were subjected to severe criticism. Today, this procedure has attained an important role in the treatment of gynaecologic cancers, offering the potential for cure to selected patients for whom no other alternatives exist. Furthermore it has been shown that patients who survive this procedure can be rehabilitated to a useful and meaningful life.

Total exenteration with removal of the pelvic viscera including the bladder and the rectosigmoid is the procedure of choice for advamced cancer of cervix within the pelvis after irradiation. In selected cases the the procedure may be limited to either anterior exenteration or posterior exenteration.

Only those patients with centrally recurrent cancer are suitable for pelvic exenteration. Metastasis outside the pelvis are considered absolute contraindications. The combined triad of unilateral leg oedema, sciatic pain, and ureteral obstruction is pathotgnomonic of recurrent and unresectable disease in the pelvis. Weight loss, cough, anaemia and other complaints suggestive of advanced disease are not sufficient justification to exclude surgical management.