[Emphasize preoperative imaging interpretation and surgical planning for total pelvic exenteration]

Area of Science:

• Oncology
• Radiology
• Surgical Oncology

Context:

• Total pelvic exenteration (TPE) is a complex procedure for advanced rectal cancers.
• Accurate preoperative evaluation is crucial for determining resectability and planning surgical strategy.
• Standardized classification systems aid in defining surgical scope and improving procedural consistency.

Purpose:

• To outline the essential role of preoperative imaging in evaluating pelvic tumors for TPE.
• To detail the imaging modalities and key anatomical considerations for surgical planning.
• To introduce a novel classification system for categorizing pelvic exenteration procedures.

Summary:

• Preoperative assessment for TPE involves contrast-enhanced CT, MRI, and PET-CT to evaluate tumor invasion and metastasis.
• Key imaging focuses include pelvic wall structures, major vascular landmarks, and the feasibility of R0 resection.
• The Changzheng Surgical Classification categorizes TPE into intra-pelvic and combined pelvic wall exenteration based on tissue involvement.

Impact:

• Enhanced preoperative planning through detailed imaging and anatomical zoning leads to standardized resection and reconstruction.
• Improved procedural consistency and R0 resection rates in patients undergoing TPE for rectal cancer.
• Facilitates multidisciplinary team discussions for optimizing neoadjuvant therapy and surgical approaches.