Introduction/Background In this educational video, we try to show and step by step procedure of anterior infra levator exenteration with colpectomy plus intraoperative radiation for recurrent/persistent cervical cancer in a patient a solitary kidney. She underwent a urinary diversion and a neovagina reconstruction.

Methodology A 31 yo woman with a past medical history of systemic lupus erythematosus and congenital absence of the left kidney was diagnosed of a 4 cm-IIA squamous cervical carcinoma in the context of immunosuppressive therapy. Beyond the proximal vaginal involvement, the work up failed to show any extra cervical disease.

She received standard concomitant chemoradiotherapy showing a questionable partial response.

Four months later after the chemoradiation, an pelvic MRI showed a 4.5 cm persistent cervical mass along with mild right hydronephrosis and vaginal involvement.

Again, a new PET-TAC confirmed the metabolic activity of the cervical tumor without demonstrating distant metastases.

Results In this video the following procedures are shown, highlighting the tips for the most complex steps:

• Anterior exenteration plus colpectomy (‘en bloc’ resection of uterus (Type D Radical Hysterectomy), bladder and vagina)

• Intraoperative radiation with electron therapy over the right pelvic side wall (infiltration of the right parametria)

• Neovagina reconstruction from a rectus abdominis musculocutaneus flap

• The urinary diversion was accomplished by means of an ileal urinary conduit (Bricker procedure) using the only right available renal unit.

The final pathological reported was 3 cm epidermoid cervical tumor with involvement of the superior vagina and right parametria.

Follow up: ten months after the surgery the patient has no shown any sign of recurrence.

Conclusion Pelvic exenteration after radiation is a challenging surgical procedure that may prolong survival in selected patients with local and persistent disease. Intraoperative Radiation allow us in provide an extra amount of radiation in the context a a previous radiated field.

Disclosure Nothing to disclose