Imaging in pelvic exenteration - a multidisciplinary practice guide from the ESGAR-SAR-ESUR-PelvEx collaborative group

Sep 22, 2026

Upload by Ophelia

Pelvic exenteration (PE) is a radical surgical strategy for curative management of advanced pelvic malignancies, requiring en-bloc resection of multiple pelvic organs. Imaging is central to preoperative planning, with MRI, CT, and PET/CT used to define cancer extent and shape a surgical roadmap. The paper provides joint clinical practice guidelines for PE imaging, created by ESGAR, SAR, ESUR, and the PelvEx Collaborative. The recommendations standardize protocols and reporting to improve preoperative assessment and support multidisciplinary decisions, aiming to optimize patient care.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Clinical relevance statement

Key Points

Keywords

Introduction

Methods

Nougaret et al. European Radiology (2025) 35:2681–2691 [https://doi.org/10.1007/s00330-024-10940-z](https://doi.org/10.1007/s00330-024-10940-z) SPECIAL REPORT Open Access Imaging in pelvic exenteration—a multidisciplinary practice guide from the ESGAR-SAR-ESUR-PelvEx collaborative group Stephanie Nougaret 1* , Doenja M. J. Lambregts2, Geerard L. Beets3, Regina G. H. Beets-Tan2, Lennart Blomqvist4, David Burling5, Quentin Denost6, Maria A. Gambacorta7, Benedetta Gui8, Ann Klopp9, Yulia Lakhman 10, Kate E. Maturen 11, Riccardo Manfredi 12, Iva Petkovska 10, Luca Russo8, Atul B. Shinagare 13, James A. Stephenson 14, Damian Tolan 15, Aradhana M. Venkatesan 16, Aaron J. Quyn 17 and Rosemarie Forstner 18 Abstract Pelvic exenteration (PE) is a radical surgical approach designed for the curative treatment of advanced pelvic malignancies, requiring en-bloc resection of multiple pelvic organs. While the procedure is radical, it has shown promise in enhancing long-term survival and is now comparable in surgical mortality to elective resections for primary pelvic cancers. Imaging plays a crucial role in preoperative planning, with MRI, CT, and PET/CT being pivotal in assessing the extent of cancer and formulating a surgical roadmap. This paper presents clinical practice guidelines for imaging in the context of PE, developed jointly by ESGAR, SAR, ESUR, and the PelvEx Collaborative. These guidelines aim to standardize imaging protocols and reporting to improve the preoperative assessment and facilitate decisionmaking in the multidisciplinary treatment of pelvic cancers. Our recommendations underscore the importance of a multidisciplinary approach and the need for clear and precise imaging reports to optimize patient care. Clinical relevance statement Our recommendations underscore the importance of a multidisciplinary approach and the need for clear and precise imaging reports to optimize patient care. Key Points ● MRI is mandatory for local staging in pelvic exenteration. ● Structured reporting (using the template provided in this guide) is recommended. ● Multidisciplinary review of imaging is critical for surgical planning. Keywords CT, MRI, PET/CT, Pelvic exenteration, Cancer Introduction Pelvic exenteration (PE) is a highly complex surgical procedure that is primarily used to treat locally advanced and recurrent pelvic cancers. This may include gastrointestinal, genitourinary, gynecologic, and occasionally Stephanie Nougaret, Doenja M. J. Lambregts, Aaron J. Quyn and Rosemarie Forstner contributed equally to this work. *Correspondence: Stephanie Nougaret stephanienougaret@free.fr Full list of author information is available at the end of the article musculoskeletal malignancies [1–5]. During this procedure, at least two pelvic organs are removed en-bloc, followed by reconstruction and/or diversion of bowel/ urinary/sexual functions. The primary objective of surgery is to excise cancer with curative intent (i.e., complete cancer resection with negative surgical margins, R0), often necessitating the removal of adjacent or involved organs, bones, muscles, nerves, and vascular structures. These extensive resections are associated with signiﬁcant morbidity and are rarely performed for palliation of symptoms alone [1–5]. The multidisciplinary team (MDT) is critical ©The Author(s) 2024, corrected publication 2025 . Open Access This article is licensed under a Creative Commons Attribution 4 .0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Comm

FAQs

What is the role of imaging in pelvic exenteration planning?

Imaging supports preoperative planning by assessing the extent of cancer and informing the surgical roadmap. The guide emphasizes MRI, CT, and PET/CT for defining disease and decisionmaking within a multidisciplinary team.

Which imaging modality is mandatory for local staging?

MRI is mandatory for local staging in pelvic exenteration, as stated in the Key Points.

Why are multidisciplinary review and structured reporting important?

Structured reporting using the provided template is recommended, and multidisciplinary review of imaging is critical for surgical planning. Clear, precise imaging reports are highlighted to optimize patient care.

Sep 22, 2026

Upload by Ophelia