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This clinical review provides a pragmatic, anatomy-driven framework to optimize preoperative assessment and multidisciplinary planning. Using a compartment-based schema\u2014central, anterior, posterior, and lateral\u2014the article maps tumor spread to structures that determine technical feasibility and functional outcomes. For each compartment, surgical implications and reporting \u201cpearls and pitfalls\u201d are summarized to ensure radiological interpretation directly informs surgical decision-making. Special attention is given to differentiating tumor infiltration from post-treatment fibrosis, particularly following chemoradiotherapy, where diffusion-weighted magnetic resonance imaging plays an important role in the attempt to differentiate residual disease from fibrosis and defining safe resection planes. The review outlines assessment of critical anatomical structures or variants that have implications for surgical planning or functional consequences for patients. In addition, reconstructive options and their imaging appearances are briefly discussed to aid postoperative assessment. Through detailed anatomical analysis and structured, compartment-based reporting, radiologists can enhance multidisciplinary communication, refine patient selection, anticipate morbidity, and ultimately increase the likelihood of achieving complete resection in pelvic exenteration.<\/jats:p>","DOI":"10.1093\/bjr\/tqag136","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T01:52:54Z","timestamp":1780537974000},"page":"1733-1752","source":"Crossref","is-referenced-by-count":0,"title":["Navigating pelvic anatomy for exenteration: a clinical guide for radiologists"],"prefix":"10.1093","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6398-8648","authenticated-orcid":false,"given":"Stephanie","family":"Nougaret","sequence":"first","affiliation":[{"name":"Department of Radiology, Montpellier Cancer Institute , 34000 Montpellier,","place":["France"]},{"name":"PINKCC Lab, U1194, Montpellier Research Cancer Institute, University of Montpellier , 34000 Montpellier,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Verity","family":"Wood","sequence":"additional","affiliation":[{"name":"Health New Zealand Te Whatu Ora Waitaha Department of Radiology, , Christchurch Hospital , Christchurch, Canterbury, 8011,","place":["New Zealand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0415-3269","authenticated-orcid":false,"given":"Phillipe","family":"Rouanet","sequence":"additional","affiliation":[{"name":"Department of Oncological Surgery, Montpellier Cancer Institute , 34000 Montpellier,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arend G J","family":"Aalbers","sequence":"additional","affiliation":[{"name":"Surgical Oncology, Netherlands Cancer Institute , Amsterdam,","place":["The 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