Navigating Pelvic Anatomy for Exenteration: A Clinical Guide for Radiologists

Area of Science:

• Oncology
• Radiology
• Surgical Anatomy

Background:

• Pelvic exenteration (PE) is a critical treatment for advanced pelvic cancers.
• Achieving an R0 (microscopically clear) margin is essential for curative intent.
• Preoperative assessment and multidisciplinary planning are vital for successful PE.

Purpose of the Study:

• To provide an anatomy-driven framework for optimizing preoperative assessment in pelvic exenteration.
• To enhance radiological interpretation for surgical decision-making.
• To improve multidisciplinary communication and patient selection for PE.

Main Methods:

• A compartment-based anatomical schema (central, anterior, posterior, lateral) is used to map tumor spread.
• Detailed analysis of radiological findings, including diffusion-weighted MRI for differentiating tumor from fibrosis.
• Review of critical anatomical structures, reconstructive options, and imaging considerations.

Main Results:

• The framework aids in assessing technical feasibility and predicting functional outcomes.
• Specific guidance is provided for radiological reporting, highlighting pearls and pitfalls.
• Emphasis on differentiating post-treatment changes from residual tumor is crucial.

Conclusions:

• Structured, compartment-based radiological reporting enhances multidisciplinary communication.
• Improved patient selection and anticipation of morbidity can increase the likelihood of complete resection.
• This anatomical approach optimizes planning and outcomes for pelvic exenteration.