E1313. What the Surgeon Wants to Know for Planning Complex Abdominal and Pelvic Surgeries: Emerging Radiologist’s Role in MRI Annotation
  1. Yu-Soon Park; Creighton University Health Sciences Phoenix
  2. Olga Kalinkin ; Creighton University Health Sciences Phoenix
  3. Anathea Powell; Creighton University Health Sciences Phoenix
The Complex Abdominal and Pelvic Surgery (CAPS) is an operation that requires substantive contribution from two or more surgical services, or a patient who has highly complex medical needs (such as cirrhosis). Indications for the CAPS include removal of residual tumor, surgical treatment of cancer, treatment of infectious and inflammatory processes, need for abdominal and pelvic reconstruction, as well as complication of multiple previous operations. CAPS multidisciplinary team holds meetings with radiologists prior to surgery. Radiologists play an important role in providing detailed annotations to identify complex anatomy in the abdomen and pelvis. In doing so, surgical subspecialists can accurately, effectively, and efficiently treat patients in the operating room while minimizing complications.

Educational Goals / Teaching Points
Explain the goal of having a new multidisciplinary team meeting prior to CAPS, illustrate the CAPS cases of annotated MRI pelvic pathology for planning of these complex pelvic surgeries, and define the role of the radiologist in the CAPS meetings to increase the success rate in obtaining the best possible free margin while simultaneously avoiding major surgical complications.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We will present illustrated cases of CAPS including locally advanced rectal/anal, prostate, and gynecologic cancers involving multiple organs in the pelvis. Each case will include an evaluation of annotated MRI images of pelvic MRI pathology for multidisciplinary assessment of ability to reach free margins. Additionally, there will be correlative intraoperative and pathologic/histologic findings.

The multidisciplinary CAPS team meetings are necessary in carefully planning surgical operations in patients who underwent neoadjuvant chemoradiotherapy for abdominal and pelvic pathologies. The radiologist plays an important role in providing detailed annotations for surgeons to increase their chances of obtaining the best possible free margins as well as identifying nearby structures that could potentially be damaged during the procedure.