Pelvic exenteration: The radiologist's role

Pelvic exenteration is a highly complex and aggressive surgical procedure that seeks to cure patients with pelvic tumours through the en bloc removal of two or more organs. Given its technical complexity and high rates of morbidity and mortality, careful selection of surgical candidates is essential, prioritising those for whom complete tumour resection is feasible. The preoperative management of these patients requires a multidisciplinary approach, with the radiologist playing a critical role. It is imperative for the radiologist to be familiar with the anatomical and pathological aspects to be assessed using different imaging techniques (CT, MRI, or PET-CT). Key considerations include the detection of extrapelvic metastatic disease, involvement of pelvic organs, neural structures, vessels, and the pelvic wall (muscular and bony components). The aim of this update is to familiarise the radiologist with pelvic exenteration, as a thorough evaluation can provide necessary information to guide the surgical team, minimise complications and avoid unnecessary interventions.