Introduction/Background In this video we show a total pelvic exenteration with a perineal phase, in an 84 year old patient with a recurrent vulvar cancer, previously treated with surgery, radiotherapy and more surgery. Clinically she complained of a lot of pain that did not even let her sit down because of a necrotic, ulcerated and exophytic vulvar lesion, that infiltrated the anterior vaginal wall, including the urethra.

Methodology Video step by step.

Results This educational video shows a step by step approach for total exenteration for recurrent vulvar cancer in a patient with a previous treatment with vulvectomy with flap and ileostomy and total radiotherapy.

We can divided the surgery in two part:

The first part of resection where we performed vulvectomy, colpectomy, resection of bladder and rectum.

The second part of reconstruction where the patient underwent urinary diversion and vulvar reconstruction. The following procedures are shown, highlighting tips for the most complex steps

• Urinary diversion was accomplished with an ileal urinary conduit (Bricker procedure) using the previous ileostomy that has the patient.

• Vulvar reconstruction from a musculocutaneous flap (VRAM).

Conclusion Pelvic exenteration after radiation is a challenging surgical procedure that may prolong survival in selected patients with local and persistent disease. In this case the objective is also increase the quality if life of the patients and to prevent the formation of a cloaca.

Disclosures No disclosure.